Laserfiche WebLink
i <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> ..........----'- ---...... Permit No...'G..�007 <br /> (Complete In Triplicate) <br /> ----------------------------....._._....-----"'"" / � 7G <br /> ���� Date Issued.. :.'..'. ..-__�-� <br /> ............................................... ........< ---_This Peimit Expires 1 Year From Date Issued <br /> oa S k�,vos.esb .J 00-4- q- r�o os <br /> Application is hereby made to the San Joaquin Local Health District for a per t to construct and install the work herein described. <br /> This application is made in compliant with County Ordinance No.549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCAT ON.......... . -. �. .......................-' 'r`.' ------CENSUS TRACT............................. . <br /> Owner's NameGG..... -'--". -.. .. .... ... ... .. !�!x ...................---.....t�.�..-..�----,y._...y........----Phone.---.-----..................------- <br /> Address... <br /> ------Address... C.13le...__ O.r.. .. . ... .. r '_......I......_... . . . . ......1....City. ..................Zip.............................. <br /> _. <br /> Contractor's Name.... .P ........_.-........Y License <br /> installation will serve: /Residence 0 Apartment Hou Co mercial❑ Trailer Court ❑ <br /> Motel ❑ Otherp`�Q20-_. 1��...'-......... / <br /> Number of living units:._yL......l..Number of bedrooms............Garbage Grinder------------Lot Size 5;..5D......._ .............. <br /> Water Supply: Public System and name---- ...-"...._........-------.......................................------------------..._..---••'- ---........Privy e <br /> Character of soil to d�depth of 3 feet: .Sand ❑ Silt❑ Clay❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> /r <br /> 'Hardpan❑ Adobe ( Fill Material............If yes,type............................... <br /> (Plot plain=showing.;siie of lot, location•bl i ystem in relation to wells, buildings,etc.must be placed on reverse side.) a <br /> i NEW iNSTALLATIOAJ: (No septic to nk or seepage pit permitted if public sewer is available within 200 feet,) / <br /> PACKAGE TRFATMENT I ] SEPTIC TANK ' Size. ......_.......... . Liquid Depth..'...............__ f, <br /> Cci oci .C2n_. T e. .... ...Materlal.....' ....._...No. Compartments...... ....... .... <br /> } P b�y Type-04 , �....................................P rs <br /> J .. �.� , ,mow s <br /> 1, Distance to nearest: Well_,ZaS...... ........................."Found __ .. ..............Prop. Lina..¢............._...Lb . <br /> LEACHNG LINE No. of Lines............................Length of each line.f ... _ ... otol Len gth..,,. n.... z24�.l�!...q- <br /> --+�- r ire . <br /> lEj)(,p 'D' Box._._.._...._Type Filter MateriaLS<��epih Filter Material_....�8..-------------......T. ......a.._.__.__,� <br /> ` Distancoto nearest: .............Foundation.__._26----_------....Property Line_S._ ....._.._0 <br /> t <br /> SEEPAGE PIT Depth................Diameter....................Number................................ Rock Filled Yes❑ No[� <br /> WaterTable Depth................................_......-------------.Rock Size..................................-............. <br /> Distance to nearest: Well...........................................Foundation..........................Prop. Line...__..._..__ ._...,,. <br /> REPAIR/ADDITION(Prev.-Sanitation Permit#.....................................-----........Date--------------------..........................) <br /> SepticTank (Specify Requirements)-----------.I...._........._............................................................................................. .............................. <br /> DisposalField (Specify Requirements)...................... ........I.-........................................................­­­................................................... <br /> ........................._.........---....-- ----. _ <br /> ._...-- _ --- _ --------------------------C ... <br /> ................ ........- _.,_....'----___ ..-•---._........_ - - <br /> _............----- ------------------ ----- <br /> (Draw existing and required addition on reverse side) <br /> 1 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 ReguWans of the San Joaquin local Health District, Home owner or licensed agents <br /> signature certifies the following: �:•�� <br /> / ' <br /> "1 certify that in the performance of the work for which this perrrliT.is Issued,11 shall not employ any person in such manner as <br /> to become [ec to We(k�nan's ompensation laws of Callfdmio.,, ' n <br /> Signed.....�!!.y....V.. ..,l��j.' - ---"---' ---""---" ............ <br /> V <br /> By..--- ...............................Tide_....... .. .. .-'-"---........._. .... <br /> (If,other th ---------- <br /> 0 <br /> wner) .,^ e. r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY=>- <br /> ........................DATE....IE .: ' <br /> DIVISIONOF LAND NUMBER.....--"'............ '------'---.._......".........................................._................DATE.'-----------------..."----------------- <br /> ADDITIONALCOMMENTS------------.................................:._........... '--._...... --'------..............--•-----------------------......._......._................ <br /> ----_-------------------- .................................................__...; .. ------"'----'.....----._........ <br /> .. <br /> FinalInspection by:..... ... .- ----- . .. .- - _--......----................Da .. .. .. .. .......----- <br /> \ W 13 2A SAN JOAQUIN LOCAL HEALTH DISTRICT Fss z:en RW.rns 3M <br />