Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT ! <br /> (Complete in Triplicate) Permit No.......... <br /> '_7-. <br /> -------------- -- - <br /> Date Issued ------Z�-�'--- <br /> ................................. __---...._._... This Permit Expires 1 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 /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION. � � 7i � ' r •�... -�. --....._:CENSUS TRACT.. <br /> -Owner's .Name ._- #�01Xep.rT <br /> �-�� T :_._.__ - Phone _... .... <br /> Address. o - ... --- <br /> ffl.11 .:.►�_.'.._.. - City,.1� 6 --Zip = ; <br /> Contractor's Name._. . .zL,e__?. <-`..'. `-- _. <br /> .License #. <br /> Installation will serve: Residen 4` Apartment'House ❑ ~ Commercial Trailer urt ❑ <br /> _ . _ <br /> Motel ❑ ,Other......:....... 3 a <br /> Number of living„units:................Number of bedrooms.__.._:. :Gar:bage GrindexRi-----....Lot Size.-.-_-_--....._.._... _ - ........ I <br /> Water Supply: Public System'.and name..................... ---------....._-----.-.--.------- ---.-Private <br /> 49 <br /> Character of soil to a depthof3 feet: Sand ❑ Silt Q Clay ❑ Peat ❑ r�Sandy Loam [] Clay Loam ❑ <br /> Hardpan ❑ Adobe F . Fill Material - ---- - - If yes,,type.............................. <br /> i <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 seepagezpit permitted if public sewer is available within 200 feet,) <br /> 21 <br /> r1 <br /> PACKAGE TREATMENT '[ ] SEPTIC'-TANK I \Size ...5.. ? 4_V � ------------------- Liquid Depth.--'Q' ----------------- <br /> W?capacity.f' .7ype � �''ss"�7 Material--------------------------No: Compartments..--- -------------..----- I <br /> r f Distance-to nearest:-Well...ACl --.......... . ..............Foundati n..36 .....Prop. Line_/.6--�..�~- ---- , <br /> LEACHING LINE ' ( '] No. of Lines- ...-.j-------------------Length of each line.......?.-Q____•..--..._Tofal- Length_:1' .Q...-_._..._.t•. :_.._.. . <br /> �...`I'D',Box... ...Ty.pe.Filter Material....................Depth Filter Material. • ...... ............. -------------- --: -------. <br /> 'SjA m Distan4 o nyresti�Well.-.-----•----------- -------Foundation--------•-------------....:.Property Line.------------ <br /> Yes No -- � <br /> 01 1 <br /> SEEPAGE E ] Depth.--- *ameter.---------- Number... Rock Filled <br /> WaterTable Depth.---•----------------------------------------------------Rock Size------... --- - -------- --------- <br /> Distance to nearest: Well------------� ...........Foundation---------- ----- - Prop. Line..------------.._...----- <br /> REPAIR/ADDITION {Prev. Sanitation Permit#-------------------.... ........... ........-------Date-....-----•--...---------------------- ------ <br /> Septic Tank (Specify Requirements)___'.__.......-...-•---------- _------------------------- - -- <br /> Disposal Field (Specify Requirements_)-...'........... ------ ------- ----------------.._..----------------------.-.---.------.--------- <br /> ............-........ <br /> - <br /> ------_------ .............. ------. <br /> I (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 Workman's Compensation laws of California.” <br /> Signed------. ' _ aly �er� .......--.-- Owner <br /> By---------- ---- - - -•- --- ................. Title -- .......--............... .............. <br /> (If other than owner) <br /> 3 FOR DEPARlbkWT USE LY ".� <br /> APPLICATION ACCEPTED BY...... 7' P------ DATE ..�/.� _:�- _.----...._._..-.-.- -- <br /> DIVISION OF )AND NUMBER. Z�� - <br /> ----- ..DATE <br /> ADDITIONAL COMMENTS..................... .. ` ......... ............... ............ _ <br /> ..--------------- <br /> t ,,-------------------------------- ------------ ------ ------ <br /> .-. - -.Date...„ -- <br /> Final inspection b <br /> EH 13 24 SAN JOAQUIN LOCAL HEALT- (STRICT F85 21677 REV. 7/76 3M <br />