Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit <br /> Date lssued-y-- ,:�.-X- ? <br /> •••-----••••------•-- ............ ----------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> dna <br /> JOB ADDRESS/LOCATION..-. ....... - 44CZ............. ..........CENSUS TRACT..-_ ..................... <br /> Owner's Name f ' ... :�� p "F, -... ".._ :. ....-_. PhoneFf;?/'75:?. --..--.. <br /> Address--------------- --- !. f Cit zip--.-. <br /> Y p---:.-..-.. <br /> Contractor's Name-------- ------ — - <br /> - ... License #-.3 .3.9.�'� Phone- �,5-.: ��.1>-....-. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other---- ....... ........... • .......... <br /> Number of living units;....-l..-------Number of bedrooms-.� <br /> -----...Garbage Grindex-..--.-..---Lot Size---- - ........ ..... .....-� <br /> Water Supply: Public System and name......-- ------ ------- -- ------- -- ----------------------- Private X ' <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat 0-.- Sandy-Loam ❑ Clay Loom ❑ <br /> Hardpan ❑ Adobe X. Fill Material . .--- ....If yes, type........................... <br /> ----- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available w'ith'in 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK Y' Size....... - sr / -------------------------Liquid Depth------- -- -------.----- i <br /> Capacity./60-0_ ------:No. Compartments.......... <br /> {� ............ <br /> i <br /> t <br /> Distance to nearest: Well:_:---,�s --� -- -------- ---------Foundation--/Q- - ----.---. - Prop. Line-.V,-91- --.--.. <br /> LEACHING LINE [,Pr' No, of Lines... --.- ---------------Length of each line.--, :�. -l..... Total Length .- .. 7Q_-- .-.-_-.-...--.--.- <br /> -r�_ <br /> ; <br /> 'D' Box----v.Type Filter Materiel Sf.�4��'-.Depth Filter Material......---l. .-..._ <br /> r � �^- <br /> Distancs to nearest: Well---_16.0..............Foundation-_ -_-....-.--..------Property Line-,,-.-s--- -----... <br /> SEEPAGE PIT [� Depth...a$-r...Diameter-.:-34_........Number-_--_- -------------------- .,, Rock Filled YesX No ❑ <br /> Water Table Depth----------2` ----------------- -----------Rock Size--.. <br /> I <br /> P ' <br /> Distance to nearest: Well.-.--/-.SZ---.........................Foundation_.__?-s---:.__........Prop. Line--.S.-_ _-...---- ....... <br /> REPAIR/ADDITION (Prev, Sanitation Permit#-------------- ----- -.Date----•--.---•---------...--.------- _------_ <br /> Septic Tank (Specify Requirements)............. ---------I— .................... <br /> Disposal Field {Specify Requirements)-------------- ----------.-------------------------------- <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 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 /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> I <br /> to become subject X657—Workman's Compensation laws of California." <br /> Signed. 1. .-`--I ...- <br /> t /��-....--Owner <br /> BY----------------- ------------------ + .. A�-tc _.Title-- -- .. ---- ....... -....------------------- ........ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ --- - ----------- --- -6: .................... --- -- - - ----------------.-DATE . - :.&V.. Z. ... - <br /> DIVISION OF LAND NUMBER................................ . ... DATE.---------------- <br /> - <br /> ADDITIONAL COMMENTS............................ ...........--.------------- ------- <br /> ----••--•----------------- .................... ---------I................................... ---------- ­---------- - -----.----....-.--....------------- .............-- .............. <br /> -------------------------- ---- ----- -------------------------------- -----------.------ -- - ---------------------------------- - ------ ------ -- - <br /> Final Inspection b ------Date....-.--- -��. <br /> Y Cn . . <br /> L EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3rn <br />