Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
•FOP OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 77_ 7141 <br /> -------------------------------------------- Permit No.---------------------- <br /> (Complete in Triplicate) <br /> ------------ --------------------------------------- <br /> Date ]ssued-. ._..,� .__77 <br /> -------------- ----------------- This Permit Expires I 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 /> JOB ADDRESS/LOCATION------------�- � U ------ --------� - ------ ---------- r� <br /> -eIQ ... p---CENSUS TRA <br /> CT-------------------------------- <br /> Phone <br /> -- ---------- ----- --- --Phone ------------------ <br /> Owner's Name. -� AX r0 ' <br /> ---------- <br /> r P ZiP------- --------------------- <br /> Address. d . Ci+> <br /> Contractor's Name------ .--------q-------- - --------------------------Liceni S7Ya..---Phone-R.3 -1a 16-e <br /> Installation will serve: Residence W Ap tment House ❑ Commercial ❑ Trailer Court ❑ l <br /> Motel Other--------------------------------------- ----- // <br /> Number of living units:--f_------------Number of bedrooms------Garbage Grinder------------Lot --- -----Q <br /> WaterSupply: Public System and name---- -------------------------------------------------------------------- ------------------------- -------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe 9 Fill Material-------------If yes, type---------------------- ------ <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 [ } Size--- _-Y--_- ---------------------------Liquid Depth.-67---.- ------ <br /> if+ X14 - . <br /> � Capacity.�ii2�'',�-- ---TYPe ------- -----Material--- �"�w----�----------No.-`ompartments__,-- _ -- ----- <br /> - ,�.. _,,,_..,Distance-to.neows.t: Well. __ 0. ----�._.�.��.�,..•Foundafion_._Z�>--r__--_-�.--Prop.-Line_=-=---.E-----�------------- <br /> - ! !f <br /> LEACHING LINE [ ] No. of Lines---� -------------------Length of each line.__I�-------------_-r. ,Total Length.-___ __-- ----- ---.---_.-_ <br /> E/ <br /> 'D' Box.. --------Type Filter MaterialX'AI-.Depth Filter Material__-_: -----------------... .._- ---------- Y <br /> t <br /> Distance to nearest: Well_/C-----.- --.Foundation---.30-7 --__.-------Property Line.--.1:57--."--_------------- <br /> I <br /> SEEPAGE PIT { ] Depth----------------Diameter-------------------_Number----.------_--___--.---------_f Rock Filled Yes ❑ No <br /> ` Water Table Depth------------------- -------.Rock Size..------------------I-------------------------- <br /> Distance to nearest: Well---------------------- -- -------- --------Foundati n--- ----------------- --.Prop. Line------------------- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#______________.-_-....._----'�" '`'. -�- Date._. ----..----....-.---._________ } <br /> Septic Tank (Specify Requirements). = '- .a ---------- ----->-------------------------t <br /> Disposal Field (Specify Requirements)---------------------- --------------- ------------------------- c, ] <br /> -- <br /> ---=---"-- <br /> ( ------- ---------- <br /> -------------- ---------------------------------------------------------------------- <br /> ------------ ----------------- ------------------------------ ----------------------- -------------------------------- � <br /> ----------------------------------------------- ----- ----------- <br /> (Draw existing and required additi.ot on reverse side) <br /> I hereby certify that I have prepared this application and that the�wort-twill be done ein accordance with San Joaquin;County <br /> Ordinances, State Laws, and Ru es_tineT_Regulations_-of�tFe San..Jc riquin Local Health District. Home owner r licensed agents <br /> signature certifies the following: <br /> "I certify that in the performance of-I a work for Ni ich--fl'iis_permg!,is-issued, I shall not employ any person in such manner as <br /> to become subject to rk �ns Compensation%laws of Calif arnnia"- <br /> 5igned. ------- <br /> I ... - <br /> BY -------------------------------------- -- - --- .. �_ �i=—_ - "tte <br /> (If other than owner) <br /> R DEPARTMENT U ONLY + <br /> APPLICATION, ACCEPTED- --------------- -DATE- —7--25— - <br /> 77 <br /> DIVISIONOF LAND NUMBER-------------_----- -------------------- ------------------------------------------------------------ DATE --- ------ ................... <br /> ADDITIONAL COMMENTS------------------------------------------------- � <br /> ---------------- <br /> , -- -- <br /> � <br /> .... _ - - --- — _w• ----- — - - <br /> ----------------- - <br />. �a <br /> -----------------------------------------�` <br /> ----------------------------------------- --- ------------- ------------- - - -- <br /> Date. - <br /> -- --- ------- - <br /> -- -------------------------------- <br /> ------- --- -- ---- ---- ------ --- - <br /> Final Inspection by:--------- ----- -- &Z-2 ------ <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br />