Laserfiche WebLink
FOR OFFICE USE: l FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT �7 <br /> -------------------------------------------- 4a /- <br /> (Complete in Triplicate) <br /> Permit Nod <br /> -• ------------------------ --- ---------------------------- <br /> �._. - _ .. Date Issued-;7 <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued 1 <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 compli 65: <br /> ��ce with County Ordinance No. 549 and existing Rules and�Reg ulations: <br /> V5..Q ._ �..... <br /> _ ' cc ` <br /> ----..CENSUS TRACT ---------------------------- <br /> JOB ADDRESS/LOCATIONc _TT,4 `� <br /> ner's Name----- - <br /> - ---- -Phone--- --------------------------- <br /> y <br /> --- - ----- <br /> • / <br /> dress--- �_- k ► -�r .. IIt Tic City- rV zip_ --- <br /> i x _� <br /> --- - <br /> 72 <br /> Contractor s- lame--;- '�,7- __^- 7� _�, :-- -.------:----- - -- --:-License # ''+t- -----Phone .._yFC7 I <br /> Instal 10t on will serve: Residence LK Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> _.. 1 Motel ❑ Other------- . 4. - <br /> --._ ------- ---i,-.., 3 t <br /> Number of living units:.5..........Number of..bedrobms`_— Garbage Grinder--L)_._L�ot Size �1 ---------------- <br /> (0,f <br /> -.__-_-_ _._ <br /> T.. <br /> Water Su I Public S stem drid ridme----'------:----- k -- * '---------------- -- -- --- --------PrivatePe <br /> ---- ' <br /> Character of-soil too depth of'3 feet: , Sand. Silt Q Ciay ❑ : Peat ❑ SandyIoarr1 ❑ Clay Loam � ?. <br /> ardpaderil._. � fYes, tYp <br /> e _-i 4__ _-H ` -------- <br /> (Plotshowing <br /> t <br /> plan, showingaize-of4l tl location.of system,in relation to w-ells, buildings,;etc;.�.rriR st be placed on reverse side.) <br /> NEW INSTALLATION: (No,septic tank-or seepage pit permitted if public sewer is available within 200 feet,) I <br /> PACKAGE TREATMENT [ ] ASEPTIC TANK [ ] - Size_ -- --- ------ <br /> -------------Liquid Depth------------------------- !! <br /> ( Capacity_Y��____TYpeA . 40. .Material --�iM�4NY ---No: Compartments--- ----------------------- <br /> _ r Distance'to nearest: Well.__._ _ _.._ ____..--- Foundation '� - .-- .Prop. Line_ �Q----------- <br /> _-__.. <br /> i LEACHING LINE ['] No. of Lines ----------- -- Length_of each Line..,__ _ -�- Total Length -/-C:7.____ i <br /> :D' Box-- �-z,- Material--'I 1 ----------------------- -- ------ <br /> . -. .- -- _.. .. . �----�---T e Filter Materia[__._----' De th Filter Mat, n.._.H�.{ ti +. <br /> - - <br /> Type � p . <br /> i Distance,to nearest: Well_; f n Foundation____ __-_ _ _Property Line_.; G _._____ <br /> - �i i , <br /> SEEPAGE PIT [ ] Depth_.__! Diarraeter -_ �` Number Rock Filled _ Yes ❑ No <br /> Water Table.De h_ - _ -_ -: _.Rock'Size --- ---• r :------- <br /> �'t . -,-- <br /> CWf <br /> Distance'tb nearest: Well__ __��---^-------______ Foundation -- --- __! Prop, Line-------------------------- <br /> Date <br /> _______________ ____ <br /> 1 -F Iw.- .. _ - __��.~-------- <br /> A <br /> __ <br /> REPAIR/ADDITION (Prev. Son itation-Permif-*_'-_� _- --------------------------• :Date_-__---------------------_ .- <br /> sR { <br /> Septic Tank (Specify Requirenients):---- - "� <br /> ----- <br /> # '°`-� �_ <br /> Disposal Field,(Specify Requiremen.ts) __ ___------�P i ..... ___ �- ------------.- <br /> ----------------------- <br /> -----{----- - -------- ------ ------------ ------ -----" ' ----- --------- <br /> =- = - ----------- ---------- --. ---------- - --- ------------- <br /> :'--- ---- <br /> ' (Drawlexistingdrid required addition on reverse side) P <br /> I hereby certify that I have prepared Ibis,applicationaad that.the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and' Regulations of Ithe San Jbaquin Local Health District, Home owner or licensed agents <br /> 1 signature certifies the following: ' } ; <br /> "I Certify that in the perfornirsnce of the work for vhich�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 /> Signed = .. ------ - Owner ' <br /> ,, . _ r <br /> _ .-Title. ---- <br /> BY ,. T <br /> �e'r <br /> /(If other <br /> /�F,ian'own�r)j�j <br /> 4 <br /> 014-1/ // L '"t OR ARTMENT USE ONLY " <br /> } APPLICATION ACCEPTED BY` T y ``- - ------------------ --------- <br /> L <br /> DIVISION OF LAND NUMBER-.. ----------- w :_ = DATE..-:--- �� :7. <br /> - -- -- - --- - - - -- --- -- -- -- DATE.,-,--.------------------------ - ----------- <br /> ADDITIONALCOMMENTS--- -----------------!�A-'---------------- ------ --------------------------------------------- -- ------ ---------------------------- ------------------ <br /> -------------------------------------------- ----------- <br /> ----------------- ----------------------------- - <br /> ' ---- . ------_.---------------------------------:---- ------------------------=--------------------- -------------- <br /> ------------------- - <br /> Final Inspection b - ------------------------------------- _. . Date---- -----�<%' 7 <br /> EH 13 24 SAN JOAQU LOCAL HEALTH DISTRICT Fes 21677 REV. 7/76 3r• <br />