Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. .�!.�....��"Z <br /> ............. (Complete in Triplicate) <br /> Date Issued .......... <br /> .. <br /> . ......:. ........................... <br /> .�...... <br /> This Permit Expires 1 Year From Date issue <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> A <br /> de priced. This application s made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> 3 3 d r :.�� � .� ...CENSUS_TRACT........ <br /> r��l <br /> JOB ADDRESS/DATION ,. nn C ................................. ..._ Phone ................................. <br /> Owner's Name -�:1.cj41ge. -•- '� li..._ .�� ,........:........................... 4 <br /> Address .._.. Phone <br /> T...-.— <br /> � �-:• --.... ...:...License # ........ . <br /> Contractor's Name ._...- , <br /> Installation will serve: Residence ottraa�nt,Hovse-oCommercial,BTtailer.Court 0 <br /> M tel ❑Other <br /> Q _.Private lr3 <br /> Garbag� G,�,�rindn..er .-••••-•. <br /> Lot Size . .. --••-(::�. .......... .. <br /> Number of living units:.--�------- INumbe of .bedrooms __ .. --_-•- �� II <br /> • •-- --------- --•--..............._..... .............. � - <br /> Water Su�ply: Public System and nom. .. Loam [] CI y loa <br /> _* . r <br /> Charnct4r;of soil to a d'eptli of 3 feet; Sand L] Silt l] ClayPeat❑ . yy Sandy <br /> I <br /> Hardpan p=•—i4dos =Fill 1+71nterial€-yea,typ <br /> (Plot plan, showing size of lotlocation.,of�system,in:..relation. towells,.;buildings,.etc.�must be .placed on reverse alde.�` <br /> NEW INSTALLATION: (No septic•tank or seep pit permitted If ublic sewer Is available within 200 feet, 7' <br /> Size: . I X. .......... Liquid Depth . . ........... <br /> PACKAGE TREATMENT E ] SEPTICTANK -_,•._ _ .. .... <br /> Co achy .�.---..... •Type� c _Material,...:....._._.... No Compart ments •: . <br /> p Fou ion .49.�..... Prop. Line <br /> istonce�-to well <br /> ... ..�..•. ndat t �%.'l..... <br /> ,.:.�.�,. ....----. ,Length of each line....70 <br /> ..., . Total length <br /> ¢ .......... <br /> LEACHING LINE No. of i es f ...... ......... <br /> IIpp � <br /> " t ! i RQ��..:Depth Filter Material' .:..Ll... j.......... <br /> Box/ Type ria ^ <br /> n Mjoun .. Property Line .- <br /> I T e liter ate atn "" <br /> w Distance to ne resfi;Well �� <br /> )Numbetf� ... Rock Filled Ye: [) No Q <br /> �D ameter I .......................SEEPAGE!PIT ��� Qepth ............. 1• e� <br /> ��..,�..�.� Water Tble~Depth . ..... ..Rock Size .......................... <br /> * ... ................ t ... .Aundatlon .................... p. Line ...................... <br /> Distance to nearest i Well .. .t Pre <br /> REPAIR/A DITION(Prev. Sanitation Permit# ................._ •................. <br /> :Date ............................. .. :y . <br /> Septic Tank (Specify Requirements) . . .......................... I.................................................... :.. .-..................... <br /> Disposal Field (Specify Req irements . ......:............ <br /> \.. .... <br /> .......... ','.•• ................ <br /> r _ •.. .y am• ..... .a�.r�r•w' - Y•�� ..+...................................... .. ..... ..... ......+.. .::.e=•wne <br /> ...r�.pr w existin...and required .. ..............rev................................ <br /> ....�- F...........:............ ....................................... <br /> .,- x 'clition on r®verse side) <br /> ' - � ;cation-arrd�that a work will be done in accordance with San Joaquin <br /> I l hereby ertify that I have prepared-this appi Local Health District:Home owner or licen. <br /> County Ordinances, State Lowa and-Rvies and Regulations of the San Joaquin <br /> rt ;I <br /> sed agents;tghaturo certifies the followingi p1�11 arson In such manner <br /> "I certify 1hVt t the erform the rk for which thi: ermit is issued, I shall not employ.any p w <br /> as to beeom. bjo o War " an' <br /> lion laws of California." <br /> .....� 3. Owner <br /> Signed .... .. ........_.. . 1A <br /> ............. Title <br /> .......... <br /> By .......... 0 <br /> ���if other than owners <br /> ' . <br /> FOR DEPARTMENT USE ONLY <br /> L DATE ...�. '" ~� ......,_... <br /> APPLICATIbN,,ACCEPTED BY ........ ..4... - ........... ..... <br /> D"A�TLE . ._`. .................................. <br /> BUILDINGIPEAMIT ISSUED .::...................... .................... <br /> ADDITIONAL COMMENTS ........ . 1pp ........ .................................................. �........ I} ........................-.......... <br /> .._.... '� .. ............ .............• ..•... - ... .. ....••.........�_�• ......I............• / '- ............. ...........4 <br /> .� - _ <br /> Final Ins ecttiiorn b .._� T s ' ... ... ... »• .o- -- <br /> SAN JOACIUIN. LOCAL HEALTH .DISTRICT R . .,, <br /> 7172 3-X <br /> 13 24 1_,An Qe.. 51A - - - <br />