Laserfiche WebLink
I•QX OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> f ..... - (Complete in Triplicate) Permit No. 7 '..7 S <br /> .................................................... This Permit I Year From Daft / a � <br /> Date Issued ..1.. <br /> Application is hereby made to the San Joaquin Local Health District for a <br /> f described. This application Is made in compliance with County Ordinance No. 549 and ermit to nexis ng Rulestall the nd Regulations:work herein <br /> X06 ADDRESS/LOCATION ... 53� Lq� _ <br /> .... <br /> 'E..... .....................:CENSUS TRACT <br /> Owner's Nome - • 3KHj4.RD.... .. ....... .p4�.M..� <br /> ............ - 1 <br /> ...I...'•.........•..............•..a. <br /> Address Phone .. /.." <br /> ., y4 _ . .....�-��.�...-•---... City ... ,�.�•. .. � <br /> Contractor's Name _.:__...QI/U/l/ ................. .................. <br /> License <br /> •---..._+R................... _ Phone <br /> Installation ....................... <br /> wilt serve: - � .............................. <br /> Residence, Apartment House0 Commercial❑Traller Court 0 <br /> Motel Q Other ................... ..... . . . . <br /> . . . ........ <br /> Number of living units:.... ..... Number of bedrooms -...._.Garbage Grinder/ - Lot Slze ...1� „ <br /> Water Supply: Public System and name ....... <br /> --••--•-.......::.............•---•........ <br /> ....Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt p Ci y' [] Peat Q Sandy Loam p Clay Loam, <br /> Hardpan❑ Adobe g] Filf Materia! .. 40 <br /> If yes, type ............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be—placed—on reverse s(de.} <br /> NEW INSTALLATION: (No septic tank or seeps pit permitted if public sewer Is available within 200 feet,( <br /> PACKAGE TREATMEhIT f SEPTI X 1 O X r <br /> : . Size..(?.._.._.�•• -••-•---•-... <br /> i <br /> � •-•.••....-, Liquid Depth <br /> Capacity , <br /> p ty .I .._._.._- Type Material..Ci9NCI�'T_ ....••_....ky <br /> ."�--- o. Compartments .....-................ <br /> Q <br /> Distance. to nearest: Wel! f�.Q -• I f ~i_L. <br /> •------ -- -- ............Foundation .---• _ Prop. Line ...�r..� `� 6 <br /> LEACHING LINE: <br /> No. of Lines .----��_ .-:"--. -- -Length of each line._� -------------- <br /> . : � - _.._.. ...'Total Length .._.17�1...�--••-•-• � ! <br /> V Box <br /> F. Type Filter Material _R 45 ?L% Depth .Filter Material ...... <br /> Distance to nearest: wet! j�© .-... Foundation Property .` <br /> ,/ :.�l,J............... . Line .-5�. <br /> SEEPAGE l'lT [�'f �3 �w �, � M ............ <br /> ._ _ Depth .. ................. Diameter _ ..._..__....__ Number, _..- .—kotk Fill Yes �No ib <br /> Water-Table Depth ...---.-..--------------..-------••----- ------Rock Size . /� <br /> r �� <br /> . ._ rQ ,: .. w. , <br /> Distance to nearest:,Well ____1/ _ ,..� <br /> .. .... .........•------...----..Foundation __��--•-------• Prop. Line..��----• <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _............. ................ <br /> •--.....:.... Date ....................... <br /> ---------------------------------- <br /> Septic Tank (Specify Requirements) --------------------------------------- <br /> : <br /> Disposal Field (Specify Requirements) ................ _ <br /> ------- ----------- ----------------•••--•-------•--••••--- ----------------...._.:................................. <br /> I........................ <br /> (Draw existing and required addition on reverse side) :- <br /> I hereby certify that 1 have preparedthis -application and that <br /> County Ordinances, State Laws, arsd_ the work will be done in accordance with San Joaquin <br /> Rules ant! Regulations of the.San Joaquie•Locat Health;District. Hance owner or licen- <br /> sed agents signature certifies.the following: <br /> "I certify that in the performance of the work for which lhii,p ormit is issudd;4-$ball not employ any person ;in:such manner <br /> as to bec f sub ect to orkman's C- nsation laws af_Ca1ifornla." - ) <br /> Signed ..1 <br /> By ........ caner. -- — ---- - - <br /> l_ __ <br /> . --.....---- :.. , ice_ <br /> (If,other,than owner - <br /> FOR_DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY __�'r�1 O .._.__ .OpE1Z _ <br /> a ---------•-- :------ .DATE <br /> BUILDING PERMIT ISSUED .-..y`_ _ � - _ •. . <br /> ADDITIONAL COMMENTS :, = DATE _ ------ _ <br /> - ------------------•-----•- <br /> ---.._...._..----•-••----•----------------------------•--....._...I..---•-•---- <br /> ----------------------- <br /> f .. <br /> Final <br /> 1 In 2 ect-ion by: .----• ----- .. D_...... �._ <br /> --- --- • .. ..........................•---•----- -- - --.._....._......_ ate .. .. ..----- ":----• -. . ._. <br /> 3 ]-7�F# Rev. 5M <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT $/7h 3M <br />