Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------------- ----------- ' :..mss Permit No--- <br /> ------------------------------- <br /> o--. =30 <br /> ---"-------- lComp�ete in Triplicate) - <br /> ------------------------------------- ---- <br /> Date Issued_S_Ty.--�--- <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the-.Son Jo quin Local Health%District,for: a perrnit to construct and install the work herein described. <br /> This application is made incompliance'with County Ordinance No 549 and existing Rules and Regulations: �`R <br /> JOB ADDRESS/LOCATION_,.,_`- f7v_ A -----------------------tb�CENSUS TRACT.---- ------------ `-... <br /> p _ <br /> Owner's Name.: --- T _ ?v°,.._ '_ C1 •1 `. } <br /> '� - - -.-'city---C'� "K+Q7 ^� -----------------zip `l_ �36.1. <br /> `Address----- �__� I�- <br /> Contractor's Name------- �. -V- ------- �. r_�tC.h� - -_--- -------------- <br /> Apartment <br /> #-1-`k -- - --Phone---� 7`_jjq <br /> Installation'will, serve: Residence: Apartment House.Q :Commercial ❑ .Trailer Court ❑ <br /> t� Motel ❑ Other ' = ---- - - <br /> tNumber of living units: __________--Number of.bedrooms°--____.---_Garbo e Grinder t.Lot,Size ---------------------- <br /> Water <br /> --.�r--' y - - -- <br /> ----- -- <br /> Watername <br /> -- <br /> Supply: Public System 'and narrie----- --------- -----.--____------'----- �-:------- --.:--_:_::=---�. - ---"--_-_: -- ----- ----__- --- <br /> ------__ riv <br /> ' ate, <br /> Character of soil to a depth of 3 feet:# Sand ❑ `Silt❑ Clay ❑ Peat ❑ Sandy Loam Clay Loam ❑ � <br /> iHardpan ❑ : Adobe❑ Fill Material.- ---------If yes, type---"---------------------- i <br /> a(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 tahk o'r-seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ }' SEPTIC TANK ( ] Size_____:_�__ .- - -='Liquid'Depth..-_-_4�__F,__{__. <br /> C� <br /> 4 � .. Capacity/::2op..jALTypep—flL7nCA5i__Material C�t���'== No. Compartments------------------------/--�-- <br /> - , - - - --____ - Y y--- <br /> i Distance to,nearest: Well_.,-----/_ _- --------- ----'Foundation-. _�..- _-.-Prop. Line--- <br /> � t <br /> LEACHING LINE; [;] No. of L'ines{'_._�3-----------------------Length of each line--------- <br /> 1-- ------_......Total' Length-------0 _.____._. <br /> "D' Box_-L_-----Type Filter Material L��__�epth Filter Mater.ial----���---------�------- -- - -- -- <br /> _ _ ..... ... , r <br /> Distance to nearest VIle1!__.��. .. Foundation.._ o; Property Line_.._ <br /> -:-. .P , <br /> `SEEPAGE PIT ( ] Depth----------------Diameter`',-__ __:------ ----Number------------------------------- Rock Filled Yes ❑ No E]j Water Table.Depth : -------------- _.Rock Size,--- ------------------------ <br /> 'Prop. <br /> ---------- - ----- I _ <br /> L.,... Foundation '_'Prop. Line._. _ `3.1 <br /> s , w------ ------ <br /> i-"-E <br /> REPAIR/ADDITION (Prev. Sanitation Permit#_____ -- Date_-____:-----------------------------------} <br /> Distance.to nearest: e , <br /> Se tic Tank (Specify Re uir men"t l---- l.._:----..__ - - --------- --- -----,?- - -- -----�'_--=- s ------------------------------------------] <br /> p ( p Y q `` <br /> Disiposal Field (Specify Requirements),.----- --- ------- - --- - -- ------- ----- ��.`,� " <br /> --------------------------- -------=------------- ----------- ---. ; <br /> = -- ----- - --- ----------------- <br /> - ~"" {' s <br /> _ ---------- ------- - ° <br /> (Draw existing and equiied addition on reverse side) <br /> I I hereby certify that,l have,-p�e`pared�this application and-that the work will be done in acco dance-with San Joaquin County <br /> Ordinances, State Lows, and Rules and [t'egulations of the: San Joaquin Local-Health'District. Home owner-or licensed # nts <br /> signature certifies the following: }~i <br /> ..I certify that in the performance"ofrthe work fog which this perm is-sued--"hall not employ a�y person in'such manner as <br /> ,., t <br /> i <br /> to become sub' ct toW.orkman's "Compensation laws,of California <br /> T' <br /> " . - --Signed_ <br /> By-'------- ' Tit.�E <br /> e <br /> ---- - -- ------------ <br /> I <br /> (if other thanowner) - l< <br /> ' <br /> + 1 OR DEPARTMENT USE ONLY. <br /> APPLICATION ACCEPTED BY;...::__-_ DATE -- -----~-. -: - '-=-------- <br /> ..- <br /> "�►� )--------------------- <br /> --- - = --- ------- DATE <br /> DIVISION OF LAND NUMBER.------:----------------------- - - <br /> _. <br /> ------------------------------------------"-- ------- <br /> ADDITIONAL COMMENTS----=------------ �-�.------------- ------ -----;-------- -- , ---------- ----- ------- ------ ----? <br /> i1 ... . --------------- ----------------------------------------------------- -------------- <br /> I - ---------------------------- <br /> --------------------- - <br /> --- <br /> ---------------------- <br /> Fina!-Inspection•bY:..__ - Date' " - <br /> � . <br /> l� f� 7.;, <br /> EH 13 24 SAN JOAQU LOCAL HEALTH DII.�STRICT F&s 21677 W76 3M <br />