Laserfiche WebLink
, �•t• FOR-0FFICEYUSE: APPLICATION FOR SANITATION PERMIT <br />. ....--•--- ......-- •------•----•..................... Permit No. .�_.....5 <br /> {Complete in Triplicate} <br /> This Permit Expires I Year From ate is ed Date Issued /...: :r:�:. <br /> w <br /> � 44an/7s here e o e San a n ca eai �s fo a rmit to cons ruct an insta f the work herein <br /> described. This application is ad in compliance with un y r finance Na. 549 and existing vies and Regulations: <br /> JOB ADDR�S/ tCIAIION! .�..� Cal7AC c 32! N ` <br /> !i�hCENSUS TRACT ............. <br /> ............. <br /> .......... <br /> ...� <br /> Owner's Name .............lvMQ -,/N..•----...� T.��..................:...................................:....._..._...-.--••••Phone ................................---- <br /> Address ..._... .. / ................... <br /> ��. _�Crt...... . ----'T/i?_C I .. -•--•--••-•---......... City _.. �:�n�.G1`�/._._Ct4 .��. <br /> Contractor's Name .... t= <br /> License # '. _ �,.. Phone <br /> Installation will serve: Residence ®'Apartment House[] Commercial ]Trailer Court <br /> Motel Other ....---------............,..............._.,�- - — _ <br /> Number of living units:...../------ Number of bedrooms _._ .... Grinder ---......... Lot Size ........................................... <br /> Water Supply:;Public System and name ............................................. .._.-..---------•----_==----- ._.................._.......Private <br /> Character of soil to a depth of 3 feet- <br /> I Sand <br /> 0 Silt <br /> � Clay ' Peat❑ Sandy Loam JA Clay Loam n <br /> Hard pan Ada ❑ Material Qf'ti <br /> ............ If yes,type ................... -------- t <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed'on reverse side.) J <br /> NEW INSTALLATION: (No septic tank.or seepage pit permitted if public sewer is available within 200-feet,} ` <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ..................... Liquid Depth _..&_.5_/..-----_---_-.... <br /> Capacity Type RC c�s�Material...................... No. Compartments --�............ <br /> I. e / : �` l <br /> v Foundation .. .. a <br /> Distance to nearest: Well ... ........................... . 1�.._-._..':.__.. Prop. Line ____...-............ <br /> LEACHING LINE ] I Na: ,of Lines .___ -------------- Length of each line----- Total Length .......... <br /> � Xa2 / <br /> 'D t Box ---I....... Type Filter Material L..�?.....-��-Depth Filter Material ....� .f`.....:............................ ' <br /> Disttance to nearest: Well .......... Foundation ...1(.?_1.___.______. Property Line -.S.l_..____........ <br /> SEEPAGE PIT [A)� r Depth> ............ 1DIameter ................ Number ....______.___.__........... Rock Filled 'tYes [] No <br /> Water Table. Depth .Rock Size } <br /> I i <br /> 1, Distance to nearest: Well .................................Foundation P,.rop:;Line ...................... 17 <br /> I "I <br /> REPAIR/ADDITION(Prev.YSdnitotion Permit�# .:-..._--� ---:--- 'Date =...`........._••.`=`--,.)" <br /> Septic Tank (Specify Requirements) ..............................................................................-......... r.... ................................... <br /> Disposal Fieid (Specify R quirem ts) ............................. ...........------------------------------r••-•-----=-•--••--. �._.. ------- <br /> ----•--•----- ---•---•--•••...... ...... : i._.__...!___........._..-•. . ..--.._... <br /> s t (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 <br /> County Ordinances, State Laws, and Rules'•and Regulations of the San4oaquin Local Health District. Home owner or liven- <br /> sed agents signature certifies-the following—:1`tA <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 <br /> as to becomesub'ect t Workman's Compensation laws of California." y <br /> ` �. <br /> f Signed <br /> ------------ .............................------------------ Owner <br /> I <br /> By ........... <br /> .........:.................................. <br /> :._... Title <br /> (if other than owner) <br /> j OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . . .. ------------------------••---••-•-............••_.._. DATE /!� ............ <br /> BUILDINGPERMIT ISSUED ........................•--•---------•--•••-•----•-•--.._..........I........._..._ .DATE ........................................... <br /> ADDITIONAL <br /> . ..C_O_,.M... ME.N. TS ...................................................._ "-.�...... ...... --w-.a-.-.-+.+.+.�..d.Y...w....... <br /> .. . ........................� Awian.r.wiw. _..... <br /> . v.1 <br /> ...................•--••--•--.---........................ ........... ................ __._...... .......................... : 1 <br /> ........................................................ ........ .................. ....... --------'.------.____ '_..__.._._...............-------------------------------------------......... <br /> . <br /> _______________________________________ _______ __ _____ ___ ____. _._. . _ ............___.___-----------------------------------------_ ..... <br /> Final Inspection by: ---•�` •• •. -- ...... ..................................................... Date . <br /> l <br /> SAN JOAQU LOCAL HEALTH DISTRICT <br /> F u 13 241 An uav w 7/72 3 M <br />