Laserfiche WebLink
FOR OFFICE USE: r FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ---- --------- ---------------- <br /> -�----��------ - (Complete in Triplicate) Permit No._.7.__..__J`� <br /> - .._.__ <br /> ----------------- ---------------- --------------------- J <br /> Date Issued__):__.2_7_70, <br /> ---- ------------------------------------------------ This Permit Expires 1 Year From Daie'lssued <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 /> II. <br /> JOB ADDRESS/LOCATION._ /......,.r- --------- -----------CENSUS TRACT.... - <br /> Owner's Name.. -----------------------------------Phone-----�_4�_f f ._ <br /> Zip 9�.1�a <br /> Address-------------- --------- A ----- City-- AA ----- -------- <br /> -- <br /> Contractors Name-L�-T4�. cJC.�C� C�+x/� ' - ----License #._cadt7. f. Phone_.3[ ._33 <br /> i �J <br /> Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ <br /> .:Motel❑:, Other----- ------- <br /> Number,of living units:----___---------Number,of bedrooms-(_.,_.___Garbage Grinder-------- -_-Lot Size.----- -i- Q__-___.._-.--._-.---------._.__ <br /> WaaterterS fi <br /> r• � 3 <br /> Character <br /> Public System and name--- =; _ -----:- - <br /> ---- _------------------------------------------v---------------------- -----------------------------Private{� <br /> Y� <br /> of soil to a depth of 3 feet: Sand E) Silt ❑ Clay [:1 Peat ❑ San�dy.Loarii lay Loam ❑ <br /> " Hardpan ❑ Adobe.[3t te - ye <br /> Fill Marial__ _____ ..-If s,type.-._-.----',x�? ---------- <br /> Y <br /> (Plot plan, showing size of lot, location of system Viii elation to wells,­buildings,-etc._must be placed on reverse side.) *� <br /> NEW INSTALLATION: (No. septic tank or`seepage pit permitted if:public sewer is aJvailab16 itFiin 200 fee#,) <br /> r ga <br /> PACKAGE TREATMENT [ ] SEPTIC TANK fYaj— 1 Size :_ -1y.—S �_/_ _ ��-- Liquid De th___ __ ---1_-._---.-. <br /> .� 43 <br /> Capacity-- - -� � _- /-� p '-� <br /> Material---L _C'1--------'--------No.-Gom artments------.�------------- <br /> Distance to nearest: Well.--.--�..ID----------------------------Foundation_.___J<_�__ _�_ ._ Prop. Line--- _.__------- -___ <br /> 1 rfi 'ri I_ h of each line.--.--Y_Q-----------------Total-length.__._��_ --------------- <br /> LEACHING LINE [yam Na.BO XLines�.l_Type Filter Mateea th;y ��/ -------------------------------------------------- <br /> -D' t <br /> :- t-- 9 <br /> - "`'7-----ZB2pth Filter Material —Distancee to nearest: Well__J.d-S_r.____..Foundation.-___/-t7----------------.Property Line_____l7._r------------- <br /> SEEPA <br /> E PIT [Lj-� Depth_,Q 5 ----Diameter- .3-__-----Number-----_-�------------------ Rock FiIW Yes R?- No <br /> Water Table Depth___'_ --®M------------------------------------------Rock Size.-__ <br /> ------------------- - - ---- r ------------- <br /> Distance to nearest: Well------- ------------- <br /> ---------- <br /> Foundation---l4-:;;------------Prop. Line-----15--_ ---.-. <br /> 1Y I I v F <br /> REPAIR/ADDITION (Prev. Sanitation Permit#-------------- -----------------------------------Date-------------.------------K-------------i-----1 <br /> Septic Tank (Specify Requirements)-----------=�. �- ---- - - ------------------- ------ <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, I shall not employ any person in such manner as <br /> to become subject to Work n's Compensation laws of California. <br /> Signed �I. ------ ---- ---- ------- Owner <br /> -� <br /> gY J - ----- - Title <br /> (l other than owner[ <br /> FOR DEPARTMENT USE ONLY <br /> r �, <br /> 140 <br /> APPLICATION ACCEPTED BY---LQ - - -- --------- '- <br /> ------------- ------------- --------------- ------------------DAT( ---------------------------- <br /> DIVISIONOF LAND NUMBER--------------------- - ---------------------------------- ------ -------------------------- ----------.DATE----------------------------------- -- <br /> ADDITIONALCOMMENTS ------------------ ----------- --------------------------- ----------- ------------------------ ---------------------------------------------------- ----- <br /> ----------------------------------------------- ----- ---- --------------------- ------------------------------------- -------------------------------- ------------------I-------------------------- <br /> --------------------------------------------------------------------------------- --------------------------------- <br /> -----=-------------------------------------- - - - - ---------- -------------------------------------------------------------------------------------- <br /> Final Inspection by: - - -------- ---------------- Date .- ! l <br /> EH 13 24 A JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV, 7/76 3M <br />