Laserfiche WebLink
FOR OFFICE USE: / FOR OFFICE USE: <br /> �/ APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. :.� � ._. <br /> ----------------•-- <br /> Date Issued--- ..:fIa- 2� <br /> ...................... <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. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOC TIgN,C' .�ft` '..� a <br /> •--..CENSUS TRACT.. _.. <br /> Owner's Name..--V ............. ---- ----......_------. . --_ .... .............. Phone. _... <br /> Address 3 Y, _._ ------- .City_ . -ZIP �: _.. <br /> Contractor's Name.._ �A- ----- ...................... <br /> License #. .71. .�... .Phone �l! GC�S <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other.-/�f��yltt ---.� J? •�• <br /> Number of living units:--.-../-----Number of bedrooms...../__Garbage Grinder............Lot Size._ <br /> Water Supply: 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 Fill Material.- __.- ....If yes, type......-_.-_--------------- -- <br /> (Plot plan, showing size of lot, location of systeem_ 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 P Size _. ��,2�--.-SIX--7.. -.-.----Liquid Depth..-.7..................... <br /> Capacity..&-;+ 04------Type.p"?.C._ Mate-rial._.4 ----...No. Compartments_.-.--_ "- -- ----- --------- <br /> Distance to nearest: Well..,,/d4_....-T_......... ......Foundation_ 14 <br /> . . ------------.Pro p. Line-...._._..-.............. <br /> LEACHING LINE �(f No. of Lines__ . __..__._... gth of each line..., � / � <br /> -•--------.Len --Q_d..-_..-----..__Total Length _ ...-/--dQ -- --- -------- ••-- <br /> A* ` <br /> 'D' Box-------- Filter Material-.$$.,-PQc/�.Depth Filter Material._.._..../.�...................... .......... <br /> Distance to nearest: Well...l Q..�_ _.....Foundation._. ---------_.... .Property Line_..- / ""`---- -- --- <br /> SEEPAGE PIT Depth..;2%S-I-.-Diameter.._3_4i_-�01..-.Number_.--._-/--------------------- �� Rock Filled Yes)C No[] <br /> Water Table Depth.---...._/ t .Rock Size....--- . <br /> Distance to nearest: Well.... - --------------------------Foundation.... -...-.Prop. Line.. ._------...-...� <br /> REPAIR/ADDITION (Prev. Sanitation Permit#------------------•--------------_ -------........Date----.--_•--.._..---------_----..-------.....) <br /> Septic Tank (Specify Requirements).---- -- <br /> -- --- --------- ------------- -- - - <br /> ----- ----------------- <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, 1 shall not employ any person in such manner as <br /> to become ject to rkma Is Compensation laws of California. <br /> Signed-_ - / . . . . ..... <br /> ........ <br /> -------Owner <br /> B -•-------------•-- ------------ --------- Title_._...' ----_----.... -------------- -------- <br /> (If other than owner) <br /> R DRPARTMANT ONLY <br /> APPLICATION ACCEPTED BY " . ' % .:. <br /> �Yv�, �'` -- . --- DATE ._. `tom..._.. <br /> DIVISION OF LAND NUMBER.... ----- ---- ---- DATE__---- ----- - .---- ---- <br /> ADDITIONAL COMMENTS :/j`.7..�1 .jlJ .. . ----- - - ------ ->-- -- -- = <br /> ... -•-- . ---- -.. , ------- .................. ...... -----•----------------•--------...... -- <br /> --- - -------......... <br /> -------------------- - -- - <br /> ------ --- - --- --- - - --- <br /> ... <br /> Final Inspection by: ------ ------ ---- . ------------ ---- ---- Date. - a. . -- <br /> --- -. -- . <br /> Fes 21677 REV. <br /> EH 13 24 SAN JOAQ I LOCAL HEALTH DISTRICT /�a 3M <br />