Laserfiche WebLink
FOR OFFICE USE: <br /> ..,. <br /> APPL1CATlON FOR SANITATION PERMIT FOR OFFICE USE- <br /> .......... <br /> �' '" •� # <br /> ��...- ...... ........... ........ <br /> (Complete in Triplicate) ` / <br /> r... Date I ssued./1.-/6_ <br /> --.--- ............... r I <br /> - This Permit Expires 1 Year From Date Issued i <br /> )plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> rs application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> B <br /> [` <br /> ADDRESS/LOCATI <br /> ' <br /> �j yam- } <br /> ON r_. ...f_.J.. ......-. 0..-- Q 4_�r.Q.L --.CENSUS TRACT -- -' ---.....--- <br /> nerl's Name.-. .....-- .---•.......... .................. •----..----•-..----.----..---•.---.---.----.---..__.._...-------------------------..Phone----.---.. - <br /> dress........-. 177S.. <br /> C�... <br /> . ......... .....zi <br /> ` <br /> ' }all�mtractor's' Name........... ...��.C�..►-1........�f3-�-`.-t�.hfl_�,.-•.--�..........license #.3��`�'-"-�-�-- -Phone..��.�li <br /> 3 ation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other---------------- ---------- <br /> ` r of livingunits:.--. Number of bedrooms <br /> �m <br /> �-------• �---._Garbage Grinder------------Lot Size---.,?._ -------------•-.- .... <br /> iter Supply: Public System and name----------------- ...................... ----------------------- - ....................... ------Private 'f <br /> mracter of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> rh <br /> ? Hardpan ❑ Adobe ❑ Fill Material............{f yes, type................ ............... <br /> i <br /> it plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] <br /> :W INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> TREATMENT <br /> - i SEPTIC TANKci{ <br /> Size <br /> A�ype_f <br /> �t-t5 --------------------- ---------Liquid Depth.�-,� '..�. <br /> Capacity. -9. - Compartments-2 <br /> / ~C Material---rOhC - .. . Compartments- 2--•------------------------- <br /> ,--� Distance to nearest: Well.--.-,.-. /_7,0_... Foundation-....f.0 ......_..Prop. Line-.9.0._e ..- -- O <br /> ICHING LINE [ ] No. of Lines.--, .----.---....-------Length jf ea - -- <br /> lin g--.- ._---:Total enggth...... - •. <br /> j-P----- ------------- - <br /> DC� E-. . <br /> _• <br /> 'D' Box_I......Type Filter Material_-_ .---------.Depth Filter Materlai...: -� _ 6.;---r---_-- --- Ste, <br /> +� �---�--- ---moi! <br /> Distance to nearest: WelL:. �:- - - Foundation. .Property Line... <br /> - <br /> .L PAGE PIT <br /> j ] Depth................Diameter...----..-..---.....Number....----------------------------- Rock Filled Yes ❑ No <br /> WaterTable Depth----------- ---------------------------------------------Rock Size.................... .---- .----•--- --.. <br /> ' <br /> Distance to nearest: Well-------.................-.................-.Foundation------.----------- -- - ,Pro Line.-----.----- ....... �! <br /> `MAIR/ADDITION (Prev, Sanitation Permit#............................._.--... .-.... Date.......................................... <br /> ---.) <br /> 'tic Tank (Specify Requirements).. . ............- ............................. <br /> posal Field (Specify Requirements)-------- ------------- -•---------------- --------------------------- <br /> 1 •- ..-- <br /> ................... ........ ..................• •---------------•------------_ ----------------•---------------------- ----------------------------- ............. <br /> r-- ; <br /> ----------------- .......................----------- -------------------------------------------------------------- ------------------I—------- ................................. [ <br /> {Draw existing and required addition on reverse side) <br /> sere 'y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County '4F <br /> �iinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> f__I yre certifies the following: <br /> E <br /> 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 /> r'become s jet to Workman's Compensation laws of California." <br /> .i <br /> .----- -------------Owner <br /> ! +s- if;J . �C.h.Q`, •-------------------------- Title - ....... <br /> �---------------- <br /> (If other than owner) <br /> 1 <br /> i FOR DEPARTM E ONLY <br /> 'LI6A7ION ACCEPTED BY.---.-- - -.._- .. DATE. 111,14 <br /> . <br /> } �IISION OF LAND NUMBER....-- ...... ----- - <br /> 7D ......DATE.................................,..._.. -..... <br /> ` ITIONAL COMMENTS...- ....... <br /> r„r..............................'--------------....---......--....----........................... ----------.....-.-..-...............-_............... ... --'--...._......-'--...... ....." .....- <br /> t k <br /> ..............................---................... <br /> -- ------­------------- ............. ......... <br /> 1al Irspection>"bY ... .. -------------------------------------••------ Date. <br /> - - ... <br /> 3 sa SAN JOAQU{N L CAL HEALTH DISTRICT Fas 21677 REV. 7/76 3M <br /> 1 , <br />