Laserfiche WebLink
F . . j <br /> FOR OFFICE USE: <br /> FOR OFFICE USE: _ 'PLICATION FOR SANITATION PERMIT <br /> Permit No.. -� .5..... <br /> ................. ——......-- -•-----"'"-- (Complete in Triplicate) <br /> % Date <br /> This <br /> lssued..7 9 ?� <br /> ..._ ' This Permit Expires l Year From Date issued <br /> -� , <br /> kpplication is hereby made to-the San Joaquin Local Health District for a permit to construct andinstallthe work herein described. <br /> his application is made in compliance with County Ordinance o. 549 and existing Rules and Regulations: . <br /> iOB ADDRESS/LOCATION.... <br /> . . -- <br /> . ...... .......CENSUS TRACT:..........------. .......... <br /> - <br /> )wner's Name............ . �.._ -• -- --- ............................... ------••---•---=-::..._...-Phone.............::........ <br /> 4. 7 <br /> ........:.........City...----..........---.•--.......................Zip-..:...-•---......-....--F--- <br /> 'T I _... _ -.. License #���rif �l-1 .-. -Ph ne---.� L I1 J <br /> =ontractor's Name..... .. -. - .- --• <br /> nstallotion will serve: Residence [D Apartment House F-1CommercialE] , Trailer Court El <br /> Motel ❑ <br /> Other.'..-................ ..................... . <br /> z ! ...-. ....... .. <br /> Number of living units:..._./-------Number of bedrooms._✓L{,....Garbage Grinder._.....-....Lot Size_._.L--.-.. <br /> 44 • � .... ...............Privet <br /> e <br /> Water Supply: Public System and name....................--------- -............................................--.....I...,.....-.. _ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam.E] Clay Loam <br /> -Hardpan ❑ Adobe ❑ Fill Material_. .... .""-If yes, type---.---- -•-.-•=••--•• <br /> location of system in relation to wells, buildings, etc. must be placed on reverse side.) s <br /> (Plot plan, showing size of lot, Y <br /> _ .. <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 eel, <br /> ----.Liquid Depth... ......-.-- <br /> . <br /> Size_.. . <br /> PACKAGE TREATMENT [ ] SEP7lGTANK` [ ] � X- "- •--"' -- <br /> No. Compartments .--�7 - <br /> Capacity-/�d.�;....Type,,,.rz-•-•-.----�--Material...�,(��'Z-. . ..: P �"-'i--•-- ""--••----�--- <br /> Foundation............ ... <br /> Prop. Line_................... <br /> • Distance to nearest: We11...�=_.�..�. --� -•- -� <br /> Sype <br /> •Len th of each line.... Total LengthLEACHING LINE [ ] No. of Lines --. ---•• g'D' Box. Filter Material..... . .. Depth Filter Material...1. -•---•--• t <br /> Distant to nearest: Well...............•---------"-.Foundation._..........................Property Line....:.....:.....-.... <br /> SEEPAGE PIT [ ] Depth-- Diameter.,. <br /> -------Number------:�--------••--••-- � Rock Filled Yes No <br /> ..Rock Size.,--- .../ .f ......................... <br /> Water Table Depth................. . <br /> Distance to nearest: Well-_--------•-- •--•---- -----••--••---- Foundation-------------•• Prop. me....... <br /> REPAIR/ADDITION (Prev. Sanitation Permit#................""-.•-• - <br /> ...........Date --_----------I............ ...."-.----) <br /> ..-----•-•--------............... . <br /> Septic Tank (Specify Requirementsl........"-. ...----••......• ----•- <br /> Disposal Field (Specify Requirements)...................... ................................. <br /> ......... --- •-----------------•------- <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have--prepared'this application and that the Work will <br /> i lbe Lac l oneMeaih in acco tdance Home owner <br /> or <br /> Ordinances, <br /> agenquin j { <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin <br /> signature certifies the following: person in such manner c <br /> "I certify that in the performance of the work for which this permit is issued, ! shall net employ any <br /> to become subject to Workman's Compensation laws of California."ner <br /> Signed....-. .. ... - <br /> ------------.-- <br /> If other t an owner) <br /> FOR DEPARTMENT USE ONLY <br /> .....DATE ......... <br /> APPLICATION ACCEPTED BY.... _----•--•--- <br /> .....DAT <br /> DIVISION OF LAND NUMBE •--- ............................................... ........... <br /> . <br /> ADDITIONAL COMMENTS-............-.......-------•-......-------------•--••-------.----•- ---••----- - <br /> ------------------- --- <br /> •=---... ...............•- . ... <br /> ... <br /> --- ..--- ---- --.... <br /> ..--•.............................. [�(� - Rate.... �T�,� " <br /> Final Inspection by:.. '-ti-`• <br /> -... :--•----- ---•---•--..._._.-.. rss 21677 Qev. 7/7 <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />