Laserfiche WebLink
FOR OFFICE USE: <br /> f..T y/4 ,Fv r PLICATION <br /> FOR SANITATION PERMIT C' <br /> [Complete in Triplicate) ' Permit No: .iJ__'_ 0 <br /> -=,------ .� <br /> ------------- <br /> ' -------- y-------- ---------- This Permit Expires 1 Year From Date Issued .-Date Is'sued ------/ <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No 549 and existing Rules and Regulations- <br />!' JOB ADDRESS/LOCATIONi 17 ,..... F.j N_ 0 f} CENSUS TR C = <br /> Owner's Name --------X N_N------ i -- ' iZ0 s-5 -- 4,— _ - <br /> 2 <br /> =-:----- Phone <br /> t .-..9 = _ - <br /> Address -------- �J---9.99 -------tE,_; ----�.�3-/q v--------------- ------------ City <br /> Contractor's Name ------- -O.W11 E_R.-------------------------------------------------------------License # ---------,------ A------ Phone --------------------------- - <br /> Installation will serve: Residence (X Apartment House❑ Commercial ❑Trailer Court <br /> Motel ❑ Other ---------- <br /> Number of living units:._-----I_-__ Number of bedrooms _-,3___---Garbage Grinder _:-------- Lot Size 10-kw& _---•--_ <br /> I - � <br /> Water Supply: Public System and name -----------------_----_-------_--_ _-___--_---Private <br /> -._------------------------------------------------------------ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> r . <br /> Hardpan [] Adobe ❑ Fill Material ----- ------ If yes, type .----__--.--_--_--.-_ <br /> (Plot plan showing size 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 available within 200'feet,) <br /> PACKAGE TREATMENT- [.] _ SEPTIC TANK] Size----____-- - G,C�O- 6h.. <br /> -----3 -� - ----- a ,Liquid Depth ---------------- --------• �Q <br /> Capacity OG Type� ----_f Material-140-R-F_ E No. Compartments _____ .._- <br /> Distance to nearest: Well ---------300 <br /> - ------------------Foundation ---+Z ----- Pro - Line <br /> LEACHING LINE [ ] No. of Lines -------L-__.---------- Length of each line--------_°2_S,pTotal Leng h f So <br /> -------------------------- <br /> ` 'D' Box ------ Type Filter Material `� <br /> YP Depth Filter Material .---- -- -------------------- <br /> I + Distance to nearest: Well _--_3-0G��______ Foundation '_ "_ _ __property Line ------------------------- <br /> SEEPAGE <br /> --------------- <br /> t __ ____ <br /> SEEPAGE-PIT r it <br /> [ ) Depth ---�5___._____-- Diameter ---------------- Number - ----------------- Rock Filled Yes [Z No <br /> pp __- Number ._-.----2 <br /> Water Table Depth ------------6 G�-_�_------__ - I <br /> ., . - -----------Rock Size -------------- -------------_*;, <br /> f _�.� _� r <br /> Distance to nearest: Well-,___-____ __ _________________Foundation _..-- - .. <br /> G - = Prop. Line 7-------•----. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------- T. <br /> Date - <br /> Septic Tank (Specify Requirements) ----------------_ .`_ I <br /> -------------------------------- -- < <br /> ---------------------------------------------- <br /> Disposal .Field (Specify-.Requirements) <br /> r ------------------------------------ ``r <br /> -----. <br /> ----------------- -------------- <br /> --------------------- <br /> ------------ <br /> -------- - - - <br /> 1. <br /> ---------••--j"----------------- <br /> x <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 <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local .Health District. Home owner or licen- <br /> sed agents`signature certifies the following: <br /> "I certify that in the performance of:the work for which this permit is issued,.l shall not employ any person in such manner <br /> as to become sub'ect to Workman's Compensation laws of California." ! <br /> Signed,- -��-�---� -- - -- _. <br /> ---- - ---- -- --`''-s C -----, Owner <br /> BY Title <br /> Y <br /> f other than ow er) 4 <br /> �- ' ; <br /> { FOR DEPART 7MENT USE ONLY F <br /> APPLICATION ACCEPTED BY .._`+ --- E--- DATE ------- <br /> DING ER ED ... .. <br /> "-- --6q----------. <br /> --- -------- ----- -------------------------------------- <br /> B I <br /> PERMIT ISSUED -- - DATE ------------- <br /> ADDITIONAL COMMENTS -------- ---�_ �_--D _ ------�j_c� <br /> ----- ------ <br /> f <br /> -- ------------------ ----- ------------------------------------ <br /> ---------------- <br /> - -------------- -------------------- <br /> c--"--------- ----------------- ---------------------- <br /> --r- <br /> - - <br /> Final Ins ection b ---------:1 - <br /> p Y �`L` T ---•------•---------------------------------Date .----- <br /> `+ SANJOA UIN LOCAL HEALTH DISTRICT <br /> i <br /> E. H. 9 1-'68 Rev. 5M. I <br />