Laserfiche WebLink
FOR OFFICE- USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> _ Permit No.7.72'F� <br /> (Complete in Triplicate) <br /> �. Date <br /> •------------------------------------ '° .This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health*Distr.i't�fo a permit,to construct and install the work herein described. <br /> Thi's application is made in compliance with County'Ordinpnce'No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOC� ION___._ ----- � {� S T ; <br /> : ------------ ---------------------------------- ----.---CENSUS US RACT-------------=----.- - .... <br /> Owner's Name.° - -> = -----Phone__P .: ��� t <br /> _- ----------- <br /> Address.--- . -----=- --------------------------------------- <br /> ----- -Zi <br /> -- ------- ------• --- -----. ------ --- ------ ---- -------City -------- ---- p <br /> T ... ; . .. .. ----------------- <br /> Contractor's Name. ',` s_, ` License # 0/,5 �-----Phone- lr� o --- <br /> Installation will:serve: Residence ❑` Apartment House.❑ CommercialTrailer Court El + # <br /> Motel ❑ t Other----------=-------- <br /> . ------------- ---------- <br /> Number of.living units------------------Number of bedrooms'____- Garbdge Grinde.r..._..___-;,.Lot Size_— ____------- i <br /> ;,. <br /> Water Supply: Public System and name :: :---:---L- -- --------------------------------------.--, - -,-_------------- <br /> ---Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ l Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> t pan ❑�Adobe01 Fill Material--.--=------If yes, type----------=------=------------ ' <br /> f <br /> 4(Plot plan, showying size-of lot;-Location of system in relation to wells, buildings, etc. must be.ploced on reverse side.[ <br /> f NEW INSTALLATION: .(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i <br /> Size.--PACKAGE T.REATMENT7[]–rSEPTiCTANK [ - Liquid D p <br /> h. <br /> Capacity---------7"1', ----= ..Material--------- ---------------No. <br /> Compartments-------------------- ------------- <br /> �-"Dsonce to nearest: Well-- ---- ---- ---------- --------- •_-.__Foundation.------------ Prop.--L-_in--e---;----.-. <br /> ---_--.---~---- - - <br /> yLEACHING <br /> LINE— . 110-of Lines ----------------------Len,gth of each line -------------.------.TotaLength <br /> 'D' -- <br /> - <br /> Box " .----'_.-Tye Filter Material'-- --- ----Depth Filter Material----- --------------- ------------ <br /> `___- <br /> Distance to nearest: Well-.------- --- ------[_ __ Foundation..._`------------------------Property Line---------- <br /> SEEPAGE PIT [ j Depth- ---- ----Diameter_;---------..._.----Number .-_.._.. -_ ' ❑ N o,.®p�t <br /> i h: Water Table i Depth - I.T~ Rock Size_ r- <br /> Ny --- ----- <br /> E ` - Prop. Line ----'- . <br /> l ) Distance to nearest:Well=..:._'__:_: ___,_ -___Foundation-. _:_ <br /> Date,REPAIR/ADDITION (Prey. Sanitation Permit#_:�..__._�.__:._-____�____________________ _____ _- ..---------. _______:___.______..s_ [ <br /> Septic=onk (Specify'Req uirernents) - , ___, . _ . . •- - <br /> ;_. <br /> Disp sal Field {Specify Requirements)- .. - ----11 °-_--- �/-�' ____-. t 3 <br /> = t _ <br /> - lC S-- <br /> - <br /> ' -------------- <br /> --- -- --------------------- <------------------- ------------------------ --------------------- -------------------- --- --------- _------ ---- ----------- ----------------------- <br /> (Draw existing and required addition'on reverse side) <br /> I he'reby,certify that'] have prepared this application and that-the work will be done in accordance with San Joaquin County <br /> Ordinances,-,,State Laws, and :Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents } <br /> signature certifies the"following: <br /> "1 certify hat in the performance of the work for which this permit is issued, J shall not employ any person 1n such manner as <br /> to become jet to Wor an's ompensation: laws .of. California." t <br /> _ l <br /> Signed- 'Owner <br /> -�-_'s- ------ ------------- <br /> By it e <br /> + - - -- ------ --------- <br /> 7 [If'other than own6r[ <br /> FOR DEPARTMENT USE ONLY, <br /> t <br /> APPLICATION ACCEPTED BY_-_ - DATE.-. ." __7 '-------------- ---- <br /> . --- <br /> - ------- - - - <br /> DIVISIONOF LAND NUMBER--- - ------------------------------------------------------------ --------------------DATE------------------- -- -----------------ADDITIONAL COMMENTS -------------------------------- ---------------------------•-------------------------------------------------- ------------------ <br /> --------------- <br /> 4 .. . <br /> ----------------------- ----------------- <br /> ------------ <br /> Final Inspection by f' = " ------------------ Date_ -� �-�T _r <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br />