Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 1 0 <br /> - <br /> --------- - P6rmit No <br /> (Complete in Triplicate} <br /> -------------------------------------------------------- <br /> _-----------------------------------______---___-: This Permit Expires 1 Year From Date Issued Date issued .-._.___"_____.=7. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County O o. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LO ION ------- ,_. ;6 ------CENSUS'°TRACT --------- <br /> a <br /> Owner's Name -- - -l�s.�-�CY_�✓'�i- <br /> ---------------------------------------------=---------------------Phone ------------------------------------ <br /> Address --- --------------------z ----- - -- :------------- Cit _ _� <br /> __ ______________ _claslo 4----------------- ------ <br /> P <br /> ____ <br /> Contractor's Name iz- <br /> ---- --------------License # ---------- ----------- Phone -------------- -----------. <br /> Installation will serve: Reside ceApdrtme�ouse,❑ Commercial.[3Trailer.Court ❑ <br /> Motel.❑OgFser -�--s-'----------- <br /> ---I i <br /> Number of living units:_ ______- Number of _`_�/_._...Garbage Grinder -- -------- Lot Size,e. _ _ --------------- <br /> Y - --;-- -------------------------- Private ❑ <br /> Water Supply. Public System and name ___ __ _ <br /> Character of soil to a depth of 3 feet. Sand. Silt❑ Clay .❑`�Peat❑�-°Sa dy'#Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe ❑ Fill Material -.--_------- lf,yes.,type _-' - -----I---- -------- <br /> T y i a 1 <br /> • �Yvr..Vp(wF„+wwx...M�,..ru.�.-u�+wr _........._....x.16�� Y� <br /> (Plot plan, showing size of lot, location of system-in-relation•to.-wel•Is;,.buildi'ngs, efc.lmust be tp1aced on reverse side.) <br /> NEW INSTALLATION: •(No septic tank.or seepsa pit permitted if public sewer is availai _ble within 200 feet,} <br /> PACKAGE TREATMENT 3 # j <br /> [ l SEPTIC TANK [ Size - ---------- -- ------ Liquid Depth ----- -------------- N. <br /> 1GMaterial-e. €.� ► . ; <br /> Capacity _____ ___ TypeGr+� w __._ No. Compartments ---_-__ ....:_.__ Q <br /> s , <br /> Distance to nearest: Wel! �� ----------------------Foundation ,_________t __ Prop. Line ___ ______._________ <br /> No � ,.�; ;a <br /> Len`fi <br /> [ _ _ ______ Length of each linewl____ Total h -___-�_�f_�_-. <br /> LEACHING LINE . of Lines <br /> D' BoxFs .___ Type FilFter MateriolS _Dep#h Filter Material ------------ ------------------- <br /> � � *.� 9�i.- f, <br /> Distance to nearest: Well�l�r�__-__-__ Foundation /Q----------- --- Property Line -_'-5------_---_._____ <br /> SEEPAGE PIT [ ] Depth' ----- Diameter ---------------- Number_ -------------------------- Rock Filled Yes ❑ No i❑ <br /> Water"Table Depth ----- -=--- -- -- - Rock-Size:"------ <br /> f--- � II <br /> -------- <br /> Di stance to nearest:'Well ,_______________________________________Foundati1n -------:----------- Prop.! Line ---------------------- <br /> \ I <br /> Sanitation Permit ___.__ _ ______._ _ �__ '__-Dafie _------- `------t__--___-}. . <br /> S F f ! �.. <br /> u� <br /> Septic Tank (Specify Requirements) -------------------- ` ' ---- ------------------------------------ ------ 1 --------- <br /> Disposal Field (Specify Requirements) ,yy� -+ < .. _ -----_ _ ----- <br /> ,__i ________ _ ____ <br /> -------------------------- ----------------------------- <br /> --------- - - ------ ------------------------ <br /> \ <br /> ----- <br /> --------------------- ------------ ------- ------- =-------------------------= ------- ---------- ---- ------------------------------------ <br /> iD aw existing and required addition on reverse'side} <br /> I hereby certify that I have prepared this applic�gtion-,and that theawork will be done in laceordance with San Joaquin <br /> County Ordinances, State Laws, and Rulestand Regulatio'hs of the San Joaquin Local Health Dis ct. H me owner or licen- <br /> sed agents signature certifies the following:i i <br /> "I certify that in the performance of the Work for which this permit-.is .issued, I shall not employ dny person in such manner <br /> as to beco bject t Workman s C mpensati.on`luws of�California. <br /> Signed --- ---- ------- ------- °Owner <br /> --- ---- ` <br /> ----------------------------- <br /> -----------------------------=------------------------------ ------` �,Title ------ - --- '' -------------------- <br /> (If other than owner) <br /> FOR PiiMTAIIiNt U'si, <br /> APPLICATION ACCEPTED BY DATE _.__/�?r`/ '�: / <br /> BUILDING PERMIT ISSUED -------DATE ----•----------------------------- <br /> ADDITIONAL COMMENTS ---.;---- <br /> ----------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------- - <br /> --------------------------------------------- <br /> ------•------------------------------------------------------------------------- r ---- <br /> Final Inspection by - - ------------------------------------------------------------------..Date ---Z-_==�/`- --------- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. 5MT w ,y 3 <br />