Laserfiche WebLink
` FOR OFFICE USE: M")L Poo FOR OFFICE USE: <br /> If APPLICATION FOR SANITATION PERMIT 74 - 7f-e2 <br /> -------------------------------------------- r it o------------- <br /> (Complete in Triplicate) a+;7 Z� <br /> ----------------- -�, 7 �f <br /> ate Issued_._ ___ __ <br /> __-_----- fes-- -__________-_ 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 lRules and <br /> R qulali ns: <br /> N/ <br /> JOB ADDRESS/LOCATION------t--�-9Q- / --------' I rifu� - C------- ----CENSUS TRACT----------------------------- <br /> Owner's Name------ - Gve - _ --/------- - Gr4-------------------------- Phone--%r.2- <br /> Address----------L? ----- 1 --"-i - CitY ' i -- Zip---------------- ------------ <br /> Contractor's Name-------------7,Z,"o---------------------------------------------------------License #----------- ----------------Phone------- -------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E]me tel ❑ Other----------------------------- ---------- <br /> Number of living units:-_____ -------Number of bedrooms---/-----Garbage Grinder------------Lot Size---- ------------ (7 ---- --- <br /> Water Supply: Public System and name--------------------------------------------------------------------------------------------------- ----------- ---------------Private <br /> Character of soil to a depth of 3 feet: 'Sand ❑ Silt❑ Clay Peat❑ Sandy Loam E] Clay Loam El <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 ailable within 200 feet,) �--/ Ilk <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size__._-----__l�__�_____ _ _____________________________Liquid Dept='.___.___________...� <br /> /C o. Com <br /> Capacity- _QType_ -_-Material__ ___ ______ _ Compartments <br /> Distance to nearest: Well------�d�_______________------Foundation___/®_j_1L-----Prop. Line:_!57---- -------------- , <br /> LEACHING LINE No. of Lines_____ __________________Length of each line____� j__.---------Total Length _____ ___�____ <br /> D' Box__/.r_____Type Filter Materialls_�_—_o��Im ept alter Material__. ___________________________________________ <br /> DistanceWneares WeIL _ _ _ ----------------------------------- <br /> /_ -.-. ___. ________- Foundation____________________________.Property Line . <br /> SEEP PIT Depth_ _(K-Ki XeW.------------------Number.______-------------------- Rock Filled YNo EJ <br /> � <br /> 00 <br /> " <br /> Water Table Depth---------------------------------------------------------Rock Size--------- ----'--Z/�------------ <br /> Distance to nearest: Well--------_---------------------------.------Foundation_----------------------.Prop. Line___.__.____________-----. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#----------------------.-------------------------Date___._____.....____._-----------------------) <br /> SepticTank (Specify Requirements)-------- ------------------ -------------------------------------------------------------------------------------------------------------------- --------- <br /> Disposal Field (Specify Requirements)_______________------- -------------------------------- <br /> ----- <br /> ----- - ------- ---------- <br /> (-Draw existing and required -addition on`reverse side) <br /> 1 hereby certify that I have prepyred 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 subject to Workman's Compensation laws of California." <br /> Signed_----------`--: -------------------------------------- ---------------------------Owner <br /> BY `•.e 'l � t:.t. tires ---------------------- ------------Title.------O ------------------------------ ------- <br /> (if other than owner) -- <br /> OR DEPARTMENT USE QMY <br /> APPLICATION ACCEPTED BY-------- -------- DATE-- -2--- 7 -------------- <br /> - - --------------- <br /> DIVISION OF LAND NUMBER-------------------- - ----DATE------------------------------ ------ <br /> ADDITIONALCOMMENTS------------- - --------------------- --------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------- ---- <br /> ----- --- -- - ----- --- -- - - ------------------------------------ --- - ----- ----- <br /> ------------------------------ ---- - --- <br /> Final Inspection by ---­----------- --- ...................................................... <br /> -- ---- --- Date. <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s jt; REV. 7/76 3M <br />