Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USE: <br /> - APPLICATION FOR SANITATION PERMIT+ --------------------- --------------------- i <br /> (Complete,in Triplicate) Permit No____ ________________ <br /> --------------------------------------------------------- <br /> bate Issued----/_'T10 <br /> ----------------------- --------------------------------- This Permit Expires;j Year From Date Issued <br /> s <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> r This application its made incompliance with County Ordinanc rNo. 549 and existing Rules and R gulations: <br /> JOB ADDRESS/LOCATION <br /> 1 .dI ' <br /> L --- - -- -----CENSUS TRACT -------- i <br /> t Owner'•s Name -- --------- �Y'�'rl�[ t�"�---- --- <br /> _ .. __.�._ hoe �7 ------ <br /> Address-----=------------ f 1 , _ _. �'/�- j Pi ,. <br /> . -------'�.-+'P --'- --------------------- <br /> ------------ <br /> --------------- -------- --._ 1. - <br /> i - ; - ililcense "#.. 31Z <br /> '_-Zip = <br /> Contractor's Name .._. ---- '6'7.r•�x <br /> ° <br /> Ph ne6 <br /> Installation will serve: Residence �partment Hbuse.❑ Commercial`wi;,.i�vriler Court ❑ s <br /> { . . . . . ..�.. <br /> Motel!-[] <br /> � i ' Other- -- --- -_. . <br /> _.. --- <br /> Number.of living units:- -----Number-of bedrooms----- Garbage.Grinder.------------Ld Si <br /> ik = <br /> E <br /> Water Supply: Public System-and name ---------------------------------i-=---------- ---.--- -' <br /> Private <br /> Character of soil to a depth of 3 feet:7 Sand-❑ . Silt❑­`Clpy-, 0-!­P eat❑—Sandy L a ❑ t;Clay Loam [] ' <br /> Hardpan Ej Adobe , Fill Materia -------------If es s <br /> Y , type <br /> (Plot plan, showing 'size of lot, location of system'• in relation to-wells, buildi'ngs, etc.'must be'placed1on reverse side.) <br /> NEW INSTALLATION: (No septic tank`or''se'epage p5tte_d_ifpublicseweris availablwhin200feet PACKAGE TREATMENT { ] ~a° SEPTIC TANK :_ '- - _ Liquid Deptli. ts__ <br /> _ Capaci#yl7i[3 _ Type C Material tiC._ =NoC m 7_� <br /> - � al--- ..----- --._i ompart ents . --- --- --- <br /> _ .• Distance to nearest: Well-------- <br /> ---- Foundation l:0_e a_..______Pro Line--- <br /> LEACHING <br /> ina :LEACHING LINE [ ] No.hof Lines ___' �� .f _ <br /> p <br /> ► _. Lendth}of ea�hhla Total Length./v�_ Z <br /> 11U , <br /> D' Box ."--Type Filter M. `771D Filter Material <br /> - ----- ----- t <br /> v -� <br /> DistancEr to nearest: Well y a- <br /> - = <br /> ..� �. rope y Li• t <br /> SEEPAGE PITDepth �• .' <br /> [ ] ._ Diameter N <br /> N e <br /> umber. - _ <br /> - <br /> - 1 � Rock o ❑ <br /> Water To,ble;Depth ! f Rock Size <br /> --- � � : Roc <br /> Dist ._. 1F d . _ _: .Pro. ..Li - 4 <br /> -- - <br /> ance:to nearest: Wella:._____.' �:J � _ <br /> _ ._____Faundat,on. : Line.._ <br /> REPAIR/ DITION (Prev Sanitation P it j --------- ___p__.Date• - -4 <br /> -- - = =v <br /> ---------------------------1 <br /> SDe ank (specify Requirements]----..__-_•;-._ Ce�exxf 7.�p a----- } <br /> I ---------------------- <br /> rsposal.Field (Specify <br /> Requiremetnts)_..------- , <br /> `-.----- t <br /> i <br /> -------------- ---- T 'r r .4 <br /> ------------- <br /> .' W <br /> = rr <br /> t F <br /> - <br /> (Draw existing and required addition on'reve'rse side] l <br /> I hereby certify that'[ have prepared this application and that'the-work-will be done Lin accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules,-and Regulations of the SanWJo gdirh Local HealthtDishic#, Home owner or licensed agents <br /> signature certifies the following: ­_ <br /> "I certify that in the perforniarice of:the-work �or which" this permit is issued, -1 s II:not employ-any person in such'manner as <br /> to become subject, .to Workman's Compensation. laws of. California.'...' <br /> Signed- ----- - ! - : <br /> m .. <br /> 1 <br /> -� --- ..,- n@r � 4i <br /> QYY f <br /> By- fi------ ' <br /> wner <br /> (I o her than o . <br /> s FOR•DEPARTMENT 'USE ONLY <br /> APPLICATION ACCEPTED BY = - DATE:, $- <br /> DIVISION OF LAND NUMBER ------------------ ---- ----------------- ----' ---- -------------- ---- DATE <br /> ADDITIONAL COMMENTS------ -- ------------------------ _ ' <br /> ---------------------- <br /> ------------------------------ --- <br /> ----- ----------------------------------------------------------------- <br /> ------------------------------ ---------------- -- ------•------ - --- ------------- ----=------------------ <br /> - ----------=------------------------------------ --- - ----------------- - <br /> -- - -- - -- - - <br /> ' -------------------------- <br /> Final Ins ection•b a <br /> P Y - --- ------Date- <br /> ----------- <br /> --EH 13 24 rJ ; <br /> - SAN JOAQUIN LOCAL,'HEA 1,.H DISTRICT k r F&5 2,577 REV. 7176 31 <br />