Laserfiche WebLink
FOR OFFICE USE; FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ---- ---- Y - r I <br /> - S. A� �.���y:`�� {Complete in Trriplicate) Permit No. <br /> 9�� -_. <br /> ---------------------------------------------- --------- t t i'' , <br /> Date Issued-_ �-�_7� <br /> ._._ s _- - -.---This_P_ermit-Expires 1�far From Date Issued I <br /> J <br /> �ru <br /> Appl. ation is hereby made to the San Joaquin Local Health District for a permit-to construct and install the work herein described, <br /> This 8p3p`lib5fion-is-made in compliance with Coun# Ordinance Na. 549 and existing Rules a Re ulations: <br /> JOB ADDRESS/LOCATION. - I�{e vtl ---_-/3-:L C E <br /> ��. ,- ---:---.CENSUS TRACT ; <br /> Owner's Name_'-- -= f�t r �� S US <br /> 1. Phone_ $�R-- �-fa - <br /> Address ._ So �c � ."` t. <br /> _. <br /> t�k ,t .w _ tea... i.. --- ------------------------------ <br /> ------------- <br /> -_r__ <br /> - ----- ----- --- - <br /> �G <br /> !City ��` Zip_ <br /> Contractor s 'Name-_ _ _ ------t = ' �..fL�cense # : <br /> . .. _ ------=---Phone's A. .9r <br /> Installation will serve: Residence ❑ Apartment Novse� —Commercial,q Trailer Court ❑ <br /> Motel ---- <br /> ., <br /> Number of living units:__=--------------Number of,bedrooms------------Garbage Grinder_.- Lot Size------------- <br /> -------------___----------------- <br /> r <br /> Supply: Public System and name------------------ <br /> Water ` ) ---- <br /> {' <br /> L - _____ <br /> •- ----- � Private ❑ <br /> Character of soil to a depth of 3 feet: ' Sand [❑ Silt❑ Clay ❑ Peat ❑ Sandy.Loam ❑ Clay Loam ❑ <br /> ' ❑ . y...s� type------;---- ----------- <br /> p <br /> Hardan Adobe Fill Material._.)___.._ 1.f. e <br /> (Plot plan, showing size of'lot, location of s sfem-in relation to wells, buildings, etc, must be placed on reverse side.) e <br /> NEW INSTALLATION: f(No=septic tank or seepage ,p fs, ermitted if public sewer is available \within 200 feet,) ? <br /> PACKAGE TREATMENT [ ] +•SEPTIC TANK _ = . <br /> .�._. .._ _ Size - = Liquid Depth.- -------------- - <br /> .�. . <br /> Di . Yp pv -_._9.tis __ ---- -- Compartments--- <br /> ------------------------------ <br /> -Distance <br /> rtments-- <br /> L No. Compa <br /> Capacity �Pl� e �E _Material, c,-. <br /> stance toearest.Vile) Foundation'-- _ <br /> i i E � _` Prop. Line_IX� I <br /> LEACHING LINE [;]�'Na.;of Lmes_ _-_«`� _,_.Lendt6 ) <br /> Lengtb-d each Iirre•-- - Total Length p p <br /> D­'Box____ _._..TypIV <br /> e Filter Material__ ' --__De th Filter Material__ __ <br /> 6 -- -Dist6cato nearest;,Weli ' _ F�oundatio ___. - _: Property Line�n✓�` <br /> -- - <br /> SEEPAGE P17 --- ---- t Number _ I '". :_"' �.� .�. I <br /> I l Depth. .- ____ Diameter _. `"t [ e N <br /> ------------- <br /> ---------- <br /> --- <br /> - Y <br /> i Rock Filled s ❑ o <br /> j�Water TableDepth- ----:_ Y r ock Size -------- <br /> �-Distance-to-nearest:Well P L- <br /> i <br /> : -- - - rop:'177'6------------ <br /> REPAIR/ADDITION (P_r-ev._Sani.tatiort Permit_# ___-:_:>_�:. _ ------_-_:--_--•-- --- -_-� - <br /> Foundation--. <br /> Date=. ------------------------ <br /> Septic Tank (Specify Requirements) - _ter;::___._;_„_ -t-_ „_ s. , <br /> i <br /> Disposal Field (Specify Requirements)----_ `;`-" ,t ”; <br /> �..Y - - <br /> -- - <br /> - <br /> ! -- - P- - <br /> _____----------____ �-----------------_------------------------------------_......_ _ ___ <br /> S .__-_ <br /> (Draw existing and required ddifii if on reverse side) d <br /> I hireby certify that I have-prepared this application and that the work{will be done in .accordance -with San 'Joaquin County <br /> Ordinances, State (9W`s,and-Rules and�Regu7a:tions ofd the San Joaquini*tocal-Hedltli Distr ct-H6a ownera <br /> signature licensed agents <br /> certifies g <br /> ff <br /> certify that in the peiforM&nce' of the work for'which this permit is issued, I shall not employ any person in such manner'as <br /> gto become subject .to Workman's Compensation laws of California." <br /> ed_-_�f_ A*71_Q '�ii' ' <br /> �. , . -- -------- ---------------- -----Owner . <br /> BY- -- -- -- ----------- Title <br /> - <br /> - ------- -- <br /> other than owner <br /> FOR DEPARTMENT USE NLY <br /> _ ] <br />'-AP-..PLICATION ACCEPTED BY_______ ______ <br /> -- --- - ------- E_ ---------�-- - ------ <br /> DIVI510N:OF LAND NUM_ BEIR �:_,_- <br /> ADDITIONAL,COMMEN S - F DATE. y� <br /> �v <br /> -__._4___._________________________ v <br /> { - ------- -------- <br /> _ <br /> Final Inspection•by.--.-------- ----- - , _.. - <br /> - - - - ------------ --- - - --+-� --- ------'----- ----------�- ' Date-•--------= __-_�� �- <br /> er1 13 24 SAN JOAQUIN LOCAL,HEALTH DISTRICT Fes 21677 REV. 7176 Sea <br />