Laserfiche WebLink
= FOR OFFICEUSE: <br /> _APPLICATION FOR SANITATION PERMIT <br /> ......... .........:. -- _lComplete#rt�Triplicatel _ Permit No. ..................... <br /> j <br /> This Permit Expires I Year from Date Issued ©ate Issued <br /> ..................... . .............................. , <br /> Application Is hereb -mode-to the Son-Joaquin Dist lit,fora s <br /> �� permit to construct and-Install-'ihe work herein <br /> described. This appliecition is made inicompliance with County Ordinanee.No. 509 and existing Rules and,Regulationsr <br /> s <br /> JOB ADDRESS/LOCATIO � -•� <br /> ............ ... ...� .---...... . .. .._...-• ------�• ---.. ...........,.........CENSUS TRACT <br /> Owner's Name <br /> �.. �. . 't'i c!(......._... Ph ne .................................... <br /> Address ... f• •- C '.�` - .--•--. City _ *-:rt~--•' <br /> 1.. <br /> d..License # . �.�� Phone <br /> - --... .. <br /> Con#rac#or's Alame� r� L ._ / t <br /> installation will serve : Residence;•Apartment House Commercial[]Trailer Court C] Ok <br /> 4 q Motel (]Other- <br /> Number of living units:_..__!___.'Number of`be`d.rooms .__ . / <br /> -- -.Garbage Grinder __'.�'-_ Lot Sizei...�� r�.'�_.:����:-•.---' <br /> Water Supply: Public-System and name ..... .let 1 .. - q .....................Private tet�;`� <br /> Character of soil to a depth of 3 feet. Sand E] Silt❑ Clay 0 Peat Q Sandy Loom 0 Clay Loam ❑ <br /> s <br /> I Hardpan E] Adobe .Fill Material ._.......... If yes,type ............... ............ t <br /> {Plot plan;`showirtg'siie of lot, <br /> Location of system in relation to webs, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION:'4 I (No septic`ankaor seepage,pi$ permuttedd if public sewer is available within 200 feet,) <br /> PACKAGE:TREATMENTS{ ] SEPTIC TANK JSr/,s'ZO ---••--•. ' Liquid Depth ........................er"' <br /> ---- - <br /> Capacity .............:------ Type ................ --- Material----_------ -------- No. Compartments <br /> Dista <br /> nceo nerest: Well' ..............Foundation .. ... ..... Prop. L'ee ................... <br /> 'r <br /> Ir <br /> V. <br /> LEACH.iNG'LINE No. of Lines ---.--/------------ Length of a ch Ii e._..:_ ._....:...: Total length ... .............. <br /> D' Sox .- Tyfae Filter tenial �� <br /> _Depth Filter Material ...�.F...............: <br /> Distance to nearest Wet! Z......... Foundation 'ter' <br /> �... - .� <br /> .__�,Cr.........:.. . Property Line ... . <br /> Depth .- .:. ... Diameter : --'---"Number ........---•--....... .. Rock Filled Yea �' NoSEE <br /> I <br /> PAGE IT f <br /> �ilRock Size ----- <br /> Water Table Depth ..-.•- - p <br /> i Distance to nearest. Well - - +' r0 <br /> . ---Foundation <br /> - F Prop Line .... .: .........:.T <br /> REPAIR/ADDITION Prev. Sanitation Permit Date __} <br /> Septic'Tank (Specify Requirements) .. . <br /> I <br /> :....... <br /> ----••-- -------• <br /> Disposal Field {Specify Requirements) <br /> 1 <br /> _._____...__. ..................•-_. --_____-_-._. --- <br /> --_ _ _._ ........_...------ <br /> _------------_____________________________------ � -• - � - <br /> -�^- = {Draw-existing and required addition-on-reverse side{ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or liven. <br /> sed agents signature certifies the following: - � � t <br /> l certify that in the performance.of the work for which this permit.is issued, I shall not.employ any person in.such manner <br /> as to become subject to Workman's Compensation laws of California:'•'! F <br /> Signed ---- '... _.-.✓... -- ` <br /> � -•------------- -----••-•-•--------------. <br /> By ............. . . . .- ..._ ... .. Title ... •-� <br /> (Ifother than owner) <br /> ._ FOR DEPARTMENT USE ONLY l ' <br /> APPLICATION�ACCEPTED BY --- \.I 6 <br /> - DATE ._- ------- -----•-••-•----------- <br /> I3UiLDING PERMIT ISSUED -------------- ` ------------_----------------- -- �- - "-•-----.DATE .............. <br /> ADDITIONAL COMMENTS s � `. , <br /> - ...............--------- <br /> ---- ....... ................................ ............................................... ------.._.----------------------............ <br /> ----------- ----------•--------------• ...- <br /> -_------- -•--•-- ----------------------------------------- ---------------- <br /> ...._.....:--- <br /> P Y ... <br /> ina .Ins ection b _ - ---------•_....Date .... -- --• ----- --..��.----------• <br /> EH 13 2h 1-b 8 Rev' 5M SAN JOAQUIN LOCAL HEALTH DISTRICT $17h <br />