Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USE: <br />` APPLICATION FOR SANITATION PERMIT <br /> -----=----=---=-------------------------- ----- <br /> Permit7���� <br /> 4 No.. <br /> `�. a (Complete in Triplicate) <br /> -------------------- --- - <br /> ----------------- <br /> 9 Date Issued__. :__:/�_-_ � <br /> - --••------------ - - ---------- •-; This Permit Exp res:1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health Di�str+'ict for permit,to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance-,iNo. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION, _' /"�V- - 5------ Q� ----- - - <br /> -;- �„------ <br /> ---------- -- ---- CENSUS.TRACT------------- -------------- -- <br /> Owner's Name....---- -- hone <br /> _.�. ;-;---- - ----- - 3440---- ---------------------- <br /> .� . . <br /> Address----------------- 1 .? _q�.. ' <br /> (r' w. C'ty. Zip <br /> Contractors Name. = °I ---------- License #_ 4 '3 .3 tb- _ �Ql <br /> „ ------Phone--- - <br /> Installation vrill serve: Residence <br /> Apartment House. :Commercial Trailer Court a <br /> Motel (] Other ----------- ` <br /> tt ---------- --=------'. <br /> r - � / <br /> Number of living units:_-- J- Nurriber-:of,bed`r.'ooms: .ybarbage Grinder- -._ __: Lot Size ;_ -�)C_-? '- --_ i } <br /> Water Supply: Public System and name �. fC'-._ <br /> Y t : ------------ - ----Private ❑ i <br /> Character of soil to a depth of 3 feet: = Sand ❑ Silt (] lay Q Peat ❑ Sandy Loam ❑ 'Gay Loam ❑ <br /> r <br /> Hardpan E] Adobe1^ Fill'Mai ial_'zz- -----If yes, type---_.._______._-_.____4___..__ _ <br /> (Plot plan, showing size of lot, location of system inirelation to-wells, buildings, etc.:must be placed on reverse side.) # <br /> NEW INSTALLATION- '(No septic tank'or seepage pit pe'rm'itted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC.TAN r r l w <br /> r , <br /> I a K j.j Size ------Liquid Depth <br /> i - ------;---- ----------=-- <br /> Capacity-:---- Type- _:.y :_Material.- ---- -------:_ No. Compartments --------- <br /> D.istance'to nearest:_.Wel! '--1---:- _ =--_----- - Foun�tion- <br /> -------------- --Prop. Line.:-----.---------- --- <br /> LEACHING LINE [ .] No.-'of� Lines-' __._'_..._'_.____'_ ..."Length'of each line_„`_-_--.-_.-_-_ _ ____Total Length. _______ <br /> - - ----- <br /> D' Box Type Filter Nl�ateriaf:_._.__ ...Depth Filter Material _________ _ _ ___ ____ _ _________ <br /> -Distance to nearest: Weil- --------------------------Foundation.---.-_-- ---- - -.Property Line----------------- _ j <br /> SEEPAGE PIT [ ] Depth__:- Number________________________________ Rock Filled Yes ❑ 'No ❑ i <br /> Water Table Depth____Diameter_______• _ <br /> R ---- -.- - _ c Size -- ---------------- ----------------- <br /> _(__ �.Ro k S- <br /> Distance to nearest:'Weil`-�- - .`" ----'---"-- ------- Foundation----_-------V-,--__.-'-.Prop. Line--------------------------- <br /> ( ------ <br /> --- Date----- ------------------ ---------- <br /> Septic <br /> --- ) <br /> -------------- <br /> Septic Tank (Specify Requirements)---.- :.............r_.________._...____ <br /> Prev:Sanitation Permit# _ <br /> + _--------------___ -- ---- --_ -_-.----._---_---. _ _ <br /> Disposal Field (Specify Requiref encs).-_____a�x_. .__------,.__.- ----__ _ <br /> ----i------------=-------------------------- = I <br /> --------- - -= ��- 7i-? e-�-�, 5 <br /> I ,... ..... ---- <br /> --.-k______________________________ <br /> ---------------------------------- �--=••--------__.----------------- � '�A <br /> (Draw existing and required addition on'reverse side) <br /> I hereby certify that-) 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, Sari Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: ....Y <br /> "I certify that 'in the performance cif the'work'for which tihis permit-is issued, Fshall not emplly crit''person in such manner as <br /> to become subject .to Workman's Compensation- laws of California." . <br /> Signed ------ -- -- - _: ----------------Owner a <br /> - <br /> BY ----- -` Title_ <br /> (If other than aW-A - s , <br /> 'FO DEPARTMENT USE ONLY <br /> ACCEPTED BY`----- -=- - __., -=---------=----- -DATE ------- -f __ <br /> ----- ------------------ <br /> APPLICATION <br /> DIVISION OF LAND NUMBER-------------- -------- - = ` - . DATE <br /> -------------------------- <br /> ADDITIONAL <br /> -..ADDITIONAL COMMENTS------------ ----- f <br /> ------------- ----'-------------------- ---- ---- ----------------'------------2 :..:_ ---- -------------------- ---- <br /> - --------------------- ------ <br /> ----- ---------------------------------- <br /> ---------- <br /> -_------ --------- ------- <br /> -n------------�------- <br /> •---.--------------------------------- ---------1------ ---- <br /> -- -------- <br /> ----------- <br /> i---------- - <br /> Final-Ins ection-b --------------------------- <br /> --------- Date---- ---------------------------------------------- <br /> FH <br /> --- -----------E" i3 24 SAN JOAQUIN LOCAL HEALTH DISTRICT r&s 21677 REV, 7/76 3M <br />