Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> -------------------- ----------------------- 7 7`5/O <br /> (Complete in=Triplicate) Permit No._777 !� <br /> Date Issued--4;�__-212 ______ <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 isting Rules and Regulations: <br /> JOB A'D RESS/LOCAT -( ' <br /> +"' - --------- -- --- ---- ---------------- --- ---CENSUS TRACT------------------------- <br /> Owner's Name _ ---------------------------------------------- ------- -------------------- Phone------- <br /> 1 { r <br /> Address- -1_7342--- - - -- - -- ---------- --------------City-..-- -- ------------------------- -------Zip---------------- ------------- <br /> Contractor's Name--- --- __ .. __License # Phone___ <br /> Installation will serve: ResidenceAar m n <br /> f� p e t House❑ Commercials❑ Trailer Court ❑ <br /> Mote! F] Other-------------------- --- ------------ <br /> Number of living units:---y/-------Number of bedrooms-------Garbage Grinde,r--------I- Lot Size_ � 6 //� <br /> � . _X, <br /> Water Supply: Public System and name---- ------------------ ------------------------------------- - Private ❑ <br /> Character of soil to a de Har of 3 feet. Sand E] Silt E] Clay ❑ Peat ❑ Sandy Loam ❑ Clay Lore <br /> dpan.❑:-.-Adobe ❑ Fill Material---------.._If yes, type_ _ ____________._____-------_ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, ett 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 TANKI 11 Y <br /> [ ] Size-----7.�-S- •I Z)-----------------------Liquid Depth Y--------------------- <br /> Capacity- ______________Material-_-_. 1______No. Compartments____ <br /> --------------------- <br /> Distance to nearest: Well____ t,, -- _ _ _Foundation__-1110 ----------._.Prop�,Line--- _______._.__-__ <br /> LEACHING LINE [ ] No. of Lines._._. 2.__/-------_ Length of each IinEs___ ._:___�_---------Total Length`_, ` <br /> 'D' Box------------Type Filter Material--------------------Depth Filter Material---------------------- 41------------- <br /> Distance to nearest: Well_________ ____ <br /> ------Found ----------- <br /> sti -------- ------ Property Line------ --------------PAGE --- � <br /> [ 1 Depth-� Y-,/AO aiaxter--------------------Number------ ---------------- Rock Filled Yes,j No❑ E <br /> � � 11 <br /> Water Table Depth.---- ---- V,47------------------------------------Rock Size--- - ` <br /> Distance to nearest: Well-.,;,- ._ Foundation._�0 _.Prop. Line._._------------------__ <br /> , I= <br /> REPAIR/ADDITION {Prev. Sanitation Permit#---------I----------------------- Dat <br /> e------Y;;�.------------________________________ <br /> -M <br /> Septic Tank (Specify Requirements) A . r" <br /> Disposal Field (Specify Requirements)___..'__-- ------- ------------------ <br /> ------------- <br /> _.___.__-------------•- ------------------------------------------------------------------ -------- --------- ------------------------------------------------- <br /> I <br /> -------------------------------- ---------------------------------------------------------- --------------- <br /> (Draw existing-and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application-and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State"Laws,and'-Rutes and -Reglations,-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 10 Workman's Compensation laws of California." <br /> Signed------------ -------- -- -----------------------Owner <br /> BY---------- -- ------ -- ---- -- - Title---------------------------- ------------------------------------ <br /> �f 1 other than owner} <br /> ^- -�- - FOR DEPARTMENT USE ONLY x <br /> APPLICATION ACCEPTED BY ----- - -- w --- - ---------r­'-BATE ---... 'Z 7 --------------- <br /> DIVISION OF LAND NUMBER________________ ____ _____ <br /> -- `�- ----"- �•--� _'DATE ------------- --------------- ----- ---�-- <br /> ADDITIONAL COMMENTS_! - � �`�"� ----- <br /> --------------------------- <br /> _ _ <br /> ?i��.fw ! int - <br /> -G` .�'`'a"�'`w6- -"�'`-=''z�-----------rte'ra--- ----- --� .u. ll �y�. <br /> ---- - --- ---- -------- -- --------------- <br /> ------------------------- � <br /> --- -------- - ------ --------------- - ------------------ <br /> ----------------------------------- --- -- ------ ---- ----- <br /> Final Inspection by: <br /> - ------------------------------------------------------------------------Date - --- s' , <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3M <br />