Laserfiche WebLink
FOR OFFICE USE; FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT + <br /> ----------------- -_- � . <br /> (Complete in Triplicate) Permit No.__7.7 <br /> --------------------------------------------------------- <br /> Date issued /1'6.7n,7 <br /> ---------------------------------------------"--------"-- This Permit Expires 1 Year From Date Issued <br /> i <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 /> JOB ADDRESS/LOCATIv7 - -----------" ---- -- --------C TR --------- - ----- ------- <br /> Owner's Name------- -----_ one 7 <br /> Address------------' ---- �7 r 14-- -'-----------:City Zip <br /> _. . . ----------- --- ----------- <br /> Contractor's Name ' �'�'`' -----------'-----.-License #�s'f'3� ------Phone---_V 67 rFd O <br /> Installation` x. .... .._ ;, ... .< <br /> will serve: Residence Apartment House.❑ Commercial ❑ ,Trailer Court' ❑ <br /> i } <br /> Number.of_livin <br /> �atel ❑ <br /> Otlie r ----------==------ -------------------.-- .. ;1 <br /> g units:--_.-_ ______Number of.b.edrooms-::_..- Gar.bage-Grinder------------Lot,Size-.__cQ _x <br /> Water Supply; Public System and name -------- ------ - -----------------------------. .. ._ i---- ------ ---------- ------- Private F <br /> Character of soil to a depth of 3 fee : Sand ❑ Silt ❑ Clay ❑ ' Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> -Hardpan ❑r Adobe Fill Material_..--:------if yes, type-------------------------------- s <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 within 200 feet,] <br /> PACKAGE TREATMENT [ ] SEPTIC TANK--[L11- Size_____ ] --_--- _______ __ :_:______ Liquid <br /> ': - -- � � Depth.=______.__ _ ----------- <br /> Capacity- <br /> _______- <br /> + Ca acitY �: -�----MaterialYpe. ____ -------------- --- No. Compartments -- =-.__--- <br /> -- <br /> 4'Distance.to, ]Well3�,� ........' _ '� ------Foundati n- ___ .Prop. Line <br /> i I <br /> LEACHING LINE [ ] No, of„Lines--------. �._ .. Leyngthtof each 11na.---------------------°L 'Total Length ___,.._`_______ <br /> c 'D' Box.-l---------Type Filter Mater.ictl_-- -_-----Depth Filter Material .-'-------_ - ---_-----I---- -----------_ <br /> .. .... =---I - D1am fier-' - ----Num �er---=------'---- --- ��_ `-�_�___ Line---------------------------- 1 --.{{..LG. <br /> SEEPAG!_ PIT �est+�nce.to6nearest: �el•I_..__. Foundation-- -.---� -^ .,/property ci # � ! <br /> I 1 p k Filled Yes E] No'❑ <br /> Water Table-Depth ---------------------------------------- __ --.Roc Size _- --I----- <br /> Distance t nearest:­We11_ ......._':.___'----------------------------Foundation--- --.-- - Prop. Line._------------------ -'-- <br /> --•--- <br /> REPAIR/ADDITION (Prev. Sanitation Permit ------------------------------------------- opte.--_._- ----------------------- ------]l <br /> Septic Tank (Specify Requirements)__ ------------ <br /> ____ =__ t <br /> --- ----------------- ------ <br /> rFJispe--__I-F•,,eld (Specify Requirementsl------------- ------— X --- F--------------------- <br /> ------------------ <br /> O 1 <br /> F ------ -- <br /> - f <br /> ---------------------------------------- <br /> ----- ------a------------ -- -----------------------------------------,------------ --------------------------------- <br /> ------------------- -------------------------- <br /> i (Draw existing and required addition on reverse side[ <br /> hereby certify that I have prepared this application-and that the-work will be done inaccordancewith 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 /> to become subject to Workman's Compensation laws of California.'; <br /> t <br /> Signed--- --------------- ------ ------ .---.. = `--------------Owner } 3 <br /> �j a �j <br /> BY ------- -------- /^ �N Y = Title - - ---------- ------------- ------------_ ------ <br /> Y their than owner) .. ;. <br /> FOR DEPARTMENT USE ONLY' <br /> APPLICATION ACCEPTED BY----- <br /> ---------------------- -~'=# DATE A. <br /> --- <br /> DIVISION OF LAND NUMBER------------ -'------------- ----------- = = DATE-------------------=----------------- <br /> : : <br /> ---- -- --- -- ---- _.. . <br /> ADDITIONAL COMMENTS---------� J --- ----- - - - - ` --- <br /> ------ -- ------------------------------ ----------------------------- ----------------------------------------- <br /> r <br /> --------------------- ------------- - _.--------------- -----'----------- - <br /> --------------- _ -- - ------- --------------- ' <br /> ' �-- -----.- - <br /> -.._,.rte,. �� <br /> Final Inspection by:-- F - = = === 4..e,,---------,,.--------------------- --- I <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br />