Laserfiche WebLink
.IX, <br /> - <br />� t� I <br />, # <br /> '7R OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> (Complete In Triplicate) Permit No. <br /> This rerrnit Explres 1 Year Frons Dato Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des <br /> This application is made in c IP 'pe with County Ordinance No.549 a�ndd existing Rules and Regulations: <br /> JOB ADDRESS/LOCA ON��! `I <br /> Owner's Name !_!�' ! ,9.�K CENSUS TRACT <br /> Address <br /> Phone <br /> 'c��s•? o, <br /> // city .1.r• ; zv lt�1c,eQ Z;P <br /> ,7 <br /> Contractor's Name � ,�••,,/i� (•��� ' <br /> Installation will serve: License #t 31 "rPhone <br /> Residence 0 Apartment House❑ Commerciollo Trailer Court ❑ <br /> Motel 0 Other. <br /> Number of living units: Number of bedrooms Garbage Grinder <br /> Water Supply: Public System and name.. <br /> lot Size G{ < ' -,A-- <br /> i PP Y� . <br /> . . ... ....... .. . <br /> Character of soil to a d-4pth of 3 feet: Sand❑ Silt Prlva <br /> 1 ❑ Clay[] Peat❑ Sandy Loam y <br /> f Hardpan❑ Adobe Fill Material . If yes,type ❑ Clay loom <br /> w (Plot plan, showing size of lot, location of system in relation wells, buildings,etc, must be placed on revwt.side. <br /> t NEW INS'ALLATION: (No septic tank or seepage it 1 <br /> p permitted if public sewer is available within 200 feet,l <br /> PACKAGE TREATMENT O SEPTIC TANK K Size r <br /> p t / Liquid Depth 5.1'Capacity aZ ti 4• .Type l iV(Q��r N.3tedOI !+}L� No. Compartments e.? <br /> Distance to nearest, Well /d a.,. ............ � 1 <br /> LEACHING UNE / • •• Foundation �Q Prop. line S //�/-+• <br /> (� No, of Lines /.. Length of each line ,1C) r , <br /> Tocol length / Q <br /> '0' Box. Type Filter Materlais!/%,v <br /> ` . - Depth Filtirr Moterial ✓ <br /> Distance to nearest, Well �� ,� . Foundation /Q <br /> SEEPAGE PIT I ) Depth Property line XL/1G. <br /> --___ P DiameMr Number <br /> Water Table Depth . ........ . Rock Fig'-d Yes G Nc <br /> Rock Size <br /> Distance to nearest: Well <br /> Foundation Prop, line <br /> REPAIR/ADDITION (Prev. Sanitation permit Ar <br /> Septic Tank (Specify Requirements) Date l <br /> Disposal Field (Specify Requirements( <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have pre►.ared this application and that d+e work will be done In accordance with San Joaquin Cour. <br /> Ordinances, Stag laws, and Rules and Regulations of the San Joaquin Local Health District, <br /> signature certifies the Followinq: Home owner or licensed ager <br /> "I certify that in the perform,nce of the work for which this permit Is issued, 1 shall not employ any person in such manner , <br /> to beelom Isubjeet to Workman's Compensation laws of California." <br /> Signed ,.• <br /> By "� "•rJ .'. _ i Owner <br /> �< < Title <br /> r. <br /> I.I other than ownerj/~ <br /> --- _ O DEP RTMEN_ThilhONlY <br /> A°PLICATION ACCEPTED BY <br /> DIVISION OF LAND NI;MBER /`a� �'`T DATE <br /> ADDITIONAL COMMENTS DATE <br /> Final Inspection br <br /> fm 13 -4 Dote <br /> SAID JOAQU.N LOCAL HEALTH DISTRICT c, ; ,,, o * ,, <br />