Laserfiche WebLink
FOR OFFICE USE: y <br /> APPLICATION FOR SANITATION PERMIT ,,.//- ./�, <br /> Permit No. .7T..�'A' <br /> (Complete in Triplicate} - <br /> - ...-.... ...... This Permit Expires 1 Year From Date Issued <br /> Date Issued .Z_Z�7% <br /> ti <br /> Application is hereby made to the San Joaquin Local Health District for a 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 /> / . ....-CENSUS TRACT ....._..........-_-----. <br /> JOB ADDRESS/LOCATION <br /> /..... r-Lst�.rzli.�`. ........--_f.��t/��.-_.L-�`.�C� ./VCC�..<..- <br /> Owner's Name .-- ', K` .....CG-1l-/-. °/'1- ------------_---_-------------- _----------------------:.......Phone . - ...........-................. <br /> Address11;7C............................................................. ..... Cit <br /> Contractor's Name ._..... el_?/,F/'-----------------------------License #pT�1..-✓`. �1- Phone <br /> Installation will serve: Residence ❑Apartment House Q Commercial QTrailer Cyurt <br /> Motel ❑ Other ------------------------------- ------ <br /> Number of living units;.../---- Number of bedrooms ...,:....Garbage Grinder .%T__ Lot Size -ILL Cs'f> 5%:_............. <br /> `Water Supply: Public System and name ..--..............------------------ -------------------Privatez <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Q Clay Loam Q <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 TANKijtj Siao...d�-j�-- -f�-.��........... . . Liquid Depth -e4--y-1--------------- <br /> Capacity /_xf��...-_ Typelr.! Ai�1. Material_ <br /> 4�"&.:.-... No. Compartments . .......... <br /> " Distance to nearest: Well ------Jpo------ ........... ...Foundation ...� --.--- Prop. Line -.�eC.�r............. <br /> � <br /> LEACHING LINE jfQ No. of Lines ._.. .---_---.---- Length of each" line-%!f!>' .....__... Total Length /A .............. <br /> 'D' Box � .. Type Filter Material llel�fIZot,Depth Filter Material ./f ..................... <br /> ..........� <br /> Distance to nearest: Well ... _a............. Foundation .X- 7.....---..--.--. Property Line ./.-.1f............O <br /> SEEPAGE PIT ( Depth ..-9Jy----_.- Diameter --7.4'Fdr...- Number ...... ..........-- ...... Rock Filled Yes,0 No QGS <br /> y � r <br /> Water Table Depth --........;1:e ._..........................Rock Size - 1.:: ....... . <br /> Distance to nearest: Well -----%e/.a........... ......_Foundation .......... )Prop. Line .���.........� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ....-...-........ ............. <br /> .' Septic Tank (Specify Requirements) ------------------------------............................................................ ............-..._.-............................. P <br /> DisposalField (Specify Requirements) ------------------------------------------ ---------------------._ ....--------------------------..-..----------------------------- <br /> - - -- -- -- <br /> ------------------------.....------- ------------ - - --_ ------------ ------ -- ------------------------ -----.._..-.-.-----------------------..--------------- ------ ... <br /> -..... ._... - .-. ... - ..... ---- ------------- - --------------- ------------------ ----------------------------------------------------------............._...... <br /> (Draw existing and required addition an reverse side) <br /> ` hereby certify that 1 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, 1 shall not employ any person in such manner <br /> 'bs to become subject to Workman's Compensation laws of California." <br /> Signed ....-.... ... .... .. - ------------------------------ <br /> Owner <br /> �.. -- -.---_...._-..-....-------- <br /> - ....--- - Title- • _G'-��l'i' �r� <br /> "y (I er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY -------- ....................................- .-- .......... . __............................... DATE .......................................... <br /> BUILDINGPERMIT ISSUED ................. ...... --------..:.... . ------------------......---..........:--- .......-----..DATE ........................................... <br /> ADDITIONAL COMMENTS ............ <br /> _.......- <br /> ------....--...._---------------------------------- --------.--- - -----------._.-..--.....-- _......-------------------------------------------. <br /> . <br /> ................. .. --- -- - <br /> Final Inspection by; ............ Date <br /> -- - - --------- -- - ------------------Date -oZ---Z-.r.e`-�...---------------- <br /> SAN JOAQUIN OCAL HEALTH DISTRICT <br />