Laserfiche WebLink
FOR OFFICE U315: FOR OFFICE USE <br /> APPLICATION FOR SANITATION PERMIT g <br /> Permit No.-'7-2-`"y-"r-,/ <br /> ------------------------ -- . ---------- (Complete in Triplicate) <br /> Date Issued-"-.Tj`7� <br /> This Permit Expires I Year From Date Issued <br /> Application is hereby made to-the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> pp my Ordinance No. 549 and0existing Rules and Regulations: i <br /> County ! <br /> This application ,s made in compliance with <br /> A,10." da ar s , . ----.CENSUS TRACT---- <br /> JOB ADDRESS/LOCATION-... -. ................ ... .* <br /> Owner's Nome........ ..-. 4 - -- ..... '•.-... .... Phon -� .� . <br /> Address /... la 1�_7ty ---.--- --- :......... .:. CitY - a Z p 1. <br /> License # 5C <br /> Contractor's Name.. ne.Z.. <br /> _-i....F__: _........-... Ph [ <br /> Installation will serve: Residence F1 Apartment House F1Commercial E] Trailer Court El € <br /> F Motel ❑ Other-- ------------- r . <br /> Number of living units:...(.--. ...-_.Number of bedrooms -...Garbage Grinder.-------....Lot Size---- � private gP <br /> s Water Supply: Public-System and name- ------'--`------ "---- ` <br /> �•- <br /> .- Sand Loam - Clay Loam <br /> Character of soil to a depth of 3 feet: Sand ❑ Siltf❑ Clay [E Peat.❑ Y ❑ i <br /> ----^--•-•THbrdp-a—m-n—Ad-abe'❑—'Fill Materiol4-1---- --- If yes, type........ ----------------- _3 ti <br /> Plot lan, showingsize of lot location of system in,relation:.to wells, buildings, etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No 'septic tank or 'seepage pit permitted if public sewer is a ailabie within 200 feet,) <br /> 1 {, F <br /> Size...r<7...X'!?Z4__X 5-------- ------ ---Liquid Depth:- 7.. <br /> PACKAGE TREATMENT I ] SEPTIC TANK [ ] <br /> �....-- .... ------- <br /> capacitya <br /> //.. ---- Type -- G�z� Material------ No."Cornp�rt+rerits------.. <br /> l Distance to nearest: Well._/.J_ C�--------------:— -------Fbundation-- Line.._...- <br /> t I " <br /> LEACHING LINE [ ] No. of Lines .- _.--..------ Length of each line.. Total Length <br /> I <br /> € � _. th Filter Material....- - -- --- --------------- <br /> D' Box.: . ---...Type Filter Materlal_.1�- .. I <br /> F „] 1:57 Property Line..--�-- .._...-:_.Q <br /> Distance to nearest: Well.. ,tY1.-.--_ � ound"ation--- ► I <br /> Depth------. Rock Filled I Yes EJ No <br /> 1 SEEPAGE PIT [ ] _ -...Diameter--------.. <br /> . - .. Number..- = �. . -:':='= <br /> � �r 1 <br /> .......-...�`- -------- ------ .- -- .. <br /> Water Table Depth----•-------------•--- -- Rock Size ---- - -- -----t <br /> <. <br /> Pro Line <br /> Distance to nearest: Well----------------------- --- - Foundation...._--- <br /> . ----•..Date-------------------------- <br /> REPAIR/ADDITION <br /> ------------ --- -�- -- "----- -- - - <br /> 1 <br /> REPAIR/ADDITION (Prev. Sanitation Permit#------------- -------- V1, [ <br /> ------ <br /> r Septic Tank (Specify Requirements)...... ------ ---- ...... .... ...... ' ! <br /> '•------------- ------ --------- <br /> Disposal Field (Specify Requirements] ------ --------------------------------------------------------------- ------------ ----- <br /> t {Draw existing and required addition on reverse s cle <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with SanJoaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or, licensed agents <br /> [ <br /> signature certifies the following: ,. ...� <br /> "I certify that in The performance of the want for which this,permit-is issued, I hall:not employ any person in such manner as <br /> to become subjectto fork an's compensation laws of California." <br /> ----- -------- ----Owner <br /> -------- --------- ---- - <br /> [If other than owned # <br /> I -------- <br /> Y.QR DbARTMENT USE ONLY f <br /> F <br /> APPLICATION ACCEPTED BY- - <br /> ------ -- <br /> --------------- ----- ---- -DATE ....�-�-�©�';� -Zr-- <br /> APPLICATION <br /> .-.. <br /> l --.DATE._----- --- --'-.:w:-:--_ . <br /> DIVISION OF LAND NUMBER.-.------- mom_ .�. <br /> I AbDITtONAL COMMENTS.----- - . ------ ....... ----------- ------ <br /> I <br /> - -- . <br /> r .... ..... -----:------------- ------------ ...-- -- . - --....- ..., �.-- <br /> . <br /> --..f..-...--- <br /> - <br /> _: .. <br /> --...----_ <br /> --------- -----•-- ---------...... ....... --Date. C7` . --. ......... <br /> Final Inspection by....... -- 1' 'tom F85 21677 REV. 7/76 31 <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT C <br />