Laserfiche WebLink
` r FOR OFFICE)JSE: FOR OFFICE USE- <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------------- ------------ Permit Na;1 <br /> T_V <br /> (Complete in Triplicate) <br /> Date <br /> --------------------------------- This Permit Expires 1 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. 5.49 and existing Rules and Regul ions <br /> i JOB ADDRESS/LOCATION.... � F !<A"r....:-----.CENSUS TRACT----------------------------.-- <br /> l . 'uCkig .Owner's Name .-,- ---... ... . . G..._.................. - . <br /> Address-------- O E. Fremont St. cit Stockton zi 9 9 -----.-----.--- <br /> .... ----------- ------------ ...... Y P <br /> PARRISH__,--ANG.... ....... ...License # 100 17.--..::-_. .Phone--4 6,-X3$3-L -. <br /> Contractor's Name___________ _ ___ <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial & Trailer Court ❑ <br /> Motel ❑ Other-------------- ---------------------- <br /> Number <br /> -----------Number of living units:._"---.__-Number of bedrooms-"-....Garbage Grinder--""'-"-:__Lot Size--------.................. _--____--.------------.------ <br /> Water Supply: Public System and name.....-.Private.... ---- -- ----------------------- ------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ] Clay Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ 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 l ] SEPTIC TANK X) SizeI k ....5.1a.-.X.-5 1---X_ 5_ ------Liquid Depth. .4 <br /> Capacity_(2)1200- Type------------ --Matrial.CariC�� e _._No, Compartments.L__Pk•-•�-.-.-.3--!_� <br /> --..---.-- --------_ -0 <br /> Distance to nearest: Well_..8-90-1------......-............------Foundation-----2.01 ..-- - - ....Prop. Line... ------------ <br /> LEACHING <br /> ----------LEACHING LINE lx1 No. of Lines. ......3'--------------------Length of each line.-.-- O0........-......... Total Length .. 300.!------------..._... --•- <br /> 'D' Box..-Y.es-.Type Filter Material.._Y'OCk----- Depth Filter Material...---,_0-.............--------------- -------------"----- <br /> t <br /> Distance to nearest: Well-----�50 --__...----.Foundation_--_49-1----------------Property Line-----_--33�-.....----------.... <br /> SEEPAGE PIT �1 Depth--.?�-3f.:�-..Diameter-----. Number..------3--...................... Rock Filled Yes= No ❑ <br /> Water Table Depth---------------••----- - •------.Rock Size--.... ......... ..... '------ <br /> t <br /> Distance to nearer.t:Well------ -------- -------------- Foundation----- 4--- - --.-..Prop. Line.33.0 1---- --- -------- <br /> REPAIR/ADDITION (Prev, Sanitation Permit#.------NI-A----------- -............Date-------._......-----------.------------------- <br /> Septic <br /> ---"- ---.Septic Tank (Specify Requirements)__........ ..._....... ____ ................... <br /> Disposal Field (Specify Requirements)......-.-_'_..:... <br /> --------------- -------------- ------ --- --•--- ----- - ---------- ------------------- <br /> [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-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 ub' ct to Workman' Compensation laws of California." <br /> Signed LY/LJ'1�-t.9.-Z4r ---.Owner <br /> 4 By....... .... --�J./� C1�.ac- cA. ..Title... 5 --- <br /> 5 .:. <br /> (If other than owner) V <br /> FOR D PARTMENT USE ONLY <br /> 1 <br /> APPLICATION ACCEPTED BY+ --- -- ....... --------------------- --- <br /> DATE.-DATE -: .. .. <br /> r DIVISION OF LAND NUMBER. ---- ,--=-:_----.__,-._<. -- ------DATE <br /> r ADDITIONAL COMMENTS-..... ,-� . --- - -------------------- <br /> ----------- ................ ... ...... --------------- <br /> ------------------------------------•------ --- - ........ -•--- <br /> -... ------ --- - ........................ ----------- •----------------- ------------- <br /> -----------­ ...................... <br /> inspection b --Date.- r <br /> 4 £H 13 24SAN.JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV, 7/76 3M <br /> P <br /> 4 , <br />