Laserfiche WebLink
FOR OFFICE USE; <br /> FOR OFFICE USE,. APPLICATION FOR SANITATION PERMIT <br /> I Permit No.7?=S- <br /> ----------------------- ..... . ------- (Complete in Triplicate) <br /> ....... ...... .... ........ . .16 Date Issued-6 <br /> -N . <br /> This Permit Expires I Year From DateAssued 4 N <br /> Application is hereby made to.the Son 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 YR les and Regulations: <br /> LA <br /> C .3 C4 _CENSUS TRACT-------------- ---------- ------ <br /> ...... ........ <br /> JOB ADDRESS/LOCATIOt. 0 <br /> Phone.�W. <br /> Owner's Name ...... .-Zip----------------- <br /> Address... ---- -- -- 014�.....7 ......... ....... ... ....... <br /> Phone--- <br /> Contractor's Name---------------------- ... License <br /> Installation will serve: Residence'r5�' Apartment House [I Commercial F-1 Trailer Court F1 <br /> Motel [I Other ........ ---------- ---------- <br /> .-/(-)49 <br /> Garbqge Grinder Lot Size-- ------ - <br /> Number of living units:- ..-/-.,Number of bedrooms---- Private El <br /> M—- � .. ------------­­.... ..... ------------- - Pry <br /> Supply: Public System a,nd. Sandy Loa /Ic <br /> name--------------'-- - <br /> Sand [:1 Silt 0 Clay El Peat El Sandy Clay LoamaLoam0 <br /> Character of soil to a depth of 3 feet; , <br /> Hardpan ❑ Adobe F-1 Fill Material .... ... If yes, type...- <br /> [Plot <br /> ype_--(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. mus I t be placed on reverse side.) 0 <br /> NEW INSTALLATION (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( <br /> SEPTIC TANK ze.. <br /> 4o ...51 Liquid Depth_ <br /> -No. Compartments-------�eo. <br /> M aterial <br /> Capacity. ---Type- <br /> ..0 <br /> Distance to nearest: Well--- -- --- --- ... .. . . ..... ......Prop, Line__, <br /> LEACHING. LINE No. of L I i n_�s ------------- line.:--- .............. Total Length . --------- ------ <br /> 'D' Depth Filter M <br /> Box-_.. Type Filter Material_57r X00.4i <br /> I �_ -----Foundation- 1��o----------------Property <br /> Distance,to nearest: Wei <br /> - -- :k -L, � Rock Filled Ye No E <br /> ------------ <br /> Sff;���T Depth./-4?.'f D i a mete r. -X14)---- Number...... <br /> -Size�— ................ <br /> ck <br /> Water Table Depth--_-__ ---- do .. ...... <br /> Distance to nearest: Well._-_--.- -------------------Foundation...,/.. ...Prop. Line.5' <br /> REPAIR/ADDITION (Prev. Sanitation Permit#-----------------•----------- ----- ----------------Date ----------- <br /> 1 Septic Tank (Specify Requirements)--------__.. .-I---------- ----------------_---- -- -- ----------- - <br /> I Disposal Field (Specify Requir.ementsl..-......... ----------I- - ------------------­---- ----­----- <br /> ..'------•---------•---•----"--- <br /> -----•----•-- <br /> - -------------- <br /> .... .................. <br /> ----- - <br /> ------------------ -------------- ........ ........ ..---•------------- ........... <br /> ------------ ------ ----------------------------- (Draw existing and required addition on reverse side) <br /> he work will be done <br /> this application and that tin accordance with San Joaquin County <br /> I hereby certify that I have prepared San Joaquin Local Health iDistrict. Home owner or licensed agents <br /> Ordinances, State Laws, and Rules and Regulations of the <br /> signature certifies the.following: h manner as <br /> 2rk la Co <br /> "I certify that in the.performance of the work for which this permit is issued,'I I shall not employ any person in suc <br /> to become subject to ?n atlAnfiCalifornia." i <br /> 0. i.�n) vimo-of <br /> 0 <br /> Signed-----__--------- ------------ --- <br /> By........ --------r ......... ------- <br /> ---------- <br /> (If other than owner) <br /> FOR DVARTMEtAT USE ONLY . A <br /> ------DATE ------- ---- --- ---- -- <br /> APPLICATION ACCEPTED BY------------- - -- -- <br /> DATE. .................. ............ <br /> ----------- <br /> ---------------- ------- ............ <br /> DIVISION OF LAND NUMB E,R...... .... ----------- -- ------ ------------------------ ------ <br /> ADDITIONALCOMMENTS................ ""------------- ........................... - -------- .. ...... .... ...... <br /> --------------------- <br /> .......... .... ........ .... ------- .... <br /> --- ---------- 't...... ..... ...... ----------- ------------------------ ----------------------------I------ <br /> ...... ------------------- ....... . -- ------ -- <br /> ------------ -------I---------- ......... ---- ------------------------ -------------- ------------------ ....... ----------- ------ ---- <br /> .......Date..... -- ---- ............. ..... <br /> ------------ ...... - ---------- ---------- ------- ------- ------- <br /> Final Inspe''dion by;-------------- .... OCAL HEALTH DISTRICT r&S 21677 REV. 7/76 3A <br /> EH 13 24 SAN JOAQUIN L <br />