Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
i FOR OFFICE USE: v FOR OFFICE USE: <br /> _ APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No.7�-1b.�.� <br /> i Date <br /> -------------------------------------------------- __ -- This Permit Expires 1 Year From bate Issued <br /> h <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 /> ,� � - CENSUS TRACT ----------- -- <br /> JOS ADDRESS/LOCATI ---- -------- <br /> r r <br /> Owner's Name _' " _ Phone J"'K�r'- '3r__> <br /> Address--- 3� Z � ------ - ---- --- - - ----- -------- " Cit Zi -� �d <br /> Y c ---- -- --- p---- <br /> Contractor's Name_ 2�.-'C r_: --- --- --------- ""� --------'----'---------.----License # d------7a- ---Phone__.,t��4.4-35--3-3 <br /> Installation will serve: Residence Apartment HoeJse.❑ Commercial F1Trailer Court El <br /> -Motel ❑ Other--=---' '- ---- ---- <br /> Number of living units:--'_.f -----Number of bedrooms-_____Garbage Grinder------------Lot,Size_ Y______________________ <br /> Water Supply: Public System and'name---- -=-------------------- ---------------------------------- --- ------------ -------1----------------------------w!------- ----Private <br /> Character of soil to a depth of 3 feet: ISand E] 'Silt F] Clay 93__,_� ❑ FJ,_❑ :Sandy-Loam- --=Clay Loam r <br /> :Hardpan ❑ .l. Adobe:❑ _ Fill Material--_--:--' --If yes, type----------------- -------------- � <br /> f <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,-etc.must be placed on reJe.rse <br /> ' -• - side.jf- <br /> �� C� <br /> ' KAf.IptW-'-r. s .p.a=ga��,t ptt�if I .s. . 6ris availablew' <br /> thin 200r feet., <br /> SEPTIC -Liquid Depth---` ----_---- --- <br /> PACKAGE TREATMENT/[ TANK - --- -- <br /> Capacity--- �2_Ov_cTYPe_-----------------------Material__.- Compartments----------------------------------- <br /> & <br /> i <br /> r Distance to nearest: Well_ ---------------------------Foundation_,_ --------------Prop. Line---------------------------- - <br /> LEACHING LINE: No: of Line's��____�!___- -.____.Len th of ea�hline-- --!W_______________Total Length --- -- ---_._____.___________ <br /> [mss , g <br /> Z <br /> LL P <br /> D Bax. - Type Filter Materia �_ Depth Filter4er al -�--------------- ------------------ / } <br /> sDistance:to nearest: Well_;- --------------------- -Foundation-------------------------- Property Line___ <br /> SEEPAGE PIT { ]/ Depth ' Diameter.. s_Number---'.._~_:?----.___j�____. - Rock Filled Yes g— No ❑� <br /> - <br /> ' Watej d + iL <br /> DistanceW611- <br /> r y <br /> ' <br /> fo nearest: Well ' �- ____ -------------- <br /> ------------ <br /> _______ _Foundation Prop. Line <br /> REPAIR/ADDITION (Prev. Sanitation-Permit#_-' ` == -- '-- ---:Date----- --------------- <br /> -----------=-------_----- <br /> Septic Tanky(specifRequirements)'-- ---------- ---- -:------------------- ----------------- --------------_-:_- ---=------------------ - -----------------------� <br /> if <br /> Disposal Field,(Specify Requirements)----- --------------------------------------------------- i ' -----------------------------= <br /> a L 7i <br /> ----------- -----� ^�----`--------- - <br /> f i"(Draw existingand 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--f ollowing , <br /> '.I certify that in the perforiritnce?of:fK6-work for which this permit'is issued, :I shall not employ dny person in such manner as <br /> to become subject to Wor man's Compensation laws of California."- <br /> Signed-, --'} Owner <br /> BY# `. T --- - - <br /> {l:f 'other than owner)on r, c <br /> ' FOR DEPARTMENT USE O Y , <br /> APPLICATION ACCEPTED BY` = F " " - --- `--- p" DATE.:_ - ---- <br /> DIVISION OF LAND NUMBER.-------- , � ter ,- '' ---------------- -- -------- <br /> : " DATE------------------- <br /> t ADDITIONAL COMMENTS---- <br /> --------- - ------------ <br /> ------------------------------ <br /> t - _ 3 <br /> ---------------------------------------------------------- - ----- ------------------------------------------------ -------------------------=----------- -- ._.._..__�-- <br /> Final Inspection by:-- �' - = = _ " -- <br /> -------=---------= ----.-Date-.�.Z"-�-------- -------=----- '------ <br /> F&s 21677 REV. 7/76 3M <br /> } EH 13 24 SAN JOAQUIN LOCAL HEALTH DIST-RIOT, *' <br />