Laserfiche WebLink
` FOR OFFICE USE: 7y <br /> APPLICATION FOR SANITATION PERMIT <br /> " (Complete in Triplicate) �+ <br /> -------------------- ------ Tey7 <br /> ----_------._-- I-------- This Permit Expires 1 Year From Date Issued Date Issued ../...........-... . <br /> I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> E described. This application is made in compliance with County Ordinance Na. 549 and existing Rules and Regulations. <br /> [ JOB ADDRESS/LOCATi f �. n.__.. _..Li ---..__. .. _. '•.........................•---.....:.CENSUS TRACT ................. <br /> I _ o ........ <br /> Owner's Name -- ------- ---------------- _..__ .. f_P Pho' ,tel`-��1�� <br /> ... .. ....---.._..._.................."_:.�........ <br /> i Address ....... ........:........1-� --S'�........�--•--..-rr-- __ -- - . .� City .. ►-� / <br /> Contractor's Name .... ---- .d License #.0;.!;: .. Phone _ . ?. 607-•--• <br /> i j .• <br /> Installation will serve. Residence House[3 Commercial OTrailer Court 0 <br /> Motel O Other ...._.. . Lrb.ge <br /> --.. .. f . <br /> Number of living units:.. _(.----.. Number of bedrooms ...! r. Grinder ............. Lot Size _._.. ... ..........(- ------ <br /> Water Supply: Public System and name ._.........-"-- ............ ---"-". --•-"----------- ---- ----------- -----Private,�lf <br /> Character.of soil to a depth of 3 feet: Sand n:—Silt[D Clay-•i]r °Peat O Sandy Loam'Q Clay-.Loam 0 .- <br /> HardpanX AclobeX Fill Material ......... If yes,type ._._.............. ......... <br /> }Plot plan, showing size of lot,)location �f system in relation to wells, buildid s, etc: must be placed on reverse side.) <br /> NEW INSTALLATION- qNo septic tank ar. seepage pit permitted if public sew!is available within 200 feet,)-110A <br /> PACKAGE TREATMENT [ } SEPTIC TANK S'ze.......-��JS:. ..._...--- Licuid Depth .. ............... 4 <br /> 1 <br /> Capacity� a _ Type _. ,I" Mbterial.._ �`._ No.,Compartments - ................. <br /> i <br /> o�ndation �.'. .. .. Pro f <br /> Distance to�,nearest: ell ... fir..... _.-......... ...._ _ �` ... p. Line ._..�............. <br /> LEACHING LINE No. of Lines. th of each line .. ..:.. total Length .. ' <br /> cu <br /> e,� <br /> . ling --•C---K-......-----:._.. <br /> l: <br /> 'D' Boil- `` Ty eFilter, Materiol ---."Depth Filters Mated ----C- - ................... <br /> J� � .l ' .1 N .._.... .... -- --- Property line -� ---------to. nearest:. Well ,PCZ_._...__:_ Foundat4on` -. . _ <br /> SEEPAGE PIT (�Q Depth . zS Diameter ------ NumberRock Filled Yes No <br /> Rack Size _ . /._.._ -,7 - <br /> Water Table Depth ... - -�"------•`..�.....1 �< e / ------ <br /> Water <br /> Distance to nearest: Well .......xx)_ ._..---------.----_Foundation . 74,-. ...... Prop. Line <br /> �j <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ....... ... .....'JAJ....... ..."-"-...--""" Date ----. ..... <br /> -.._..:...._._.) <br /> Septic Tank {Specify Requirements} <br /> Disposal Field l5pecify Requirements}, : --.....-•- I :._.... <br /> ----------------- <br /> -------------------------------------- <br /> t{t5`raw#existt 'and'require�&add iion ori-r% <br /> verse sidel <br /> I herebycertify that I have prepared-..this.application_and-th,at--the.work will-be--done-�in-accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.;Home ownerner lice". <br /> = sed agents signature'certif es the following: <br /> ! "I certifyjthat in the performance,of the work for which this permit is issued, I shall not employ any person in such ,manner <br /> as to become subject to Workman's Compensation laws of California." # <br /> Signed .: .. . - Owner <br /> IBy .. ---. Title . .... .. . .... -- -- ...... .. ............... <br /> (I oth han owner) i <br /> FOR ,E,!,RTMENT.'U,,E ONLY <br /> APPLICATION ACCEPTED BY ............. r ............. ...........-__..... DATE ._ .�.�. ..__,._ _........___ <br /> { BUILDING PERMIT ISSUED ._._.. _...... .... ...... ... :........ ... .........---- .... ..__._......... :. ..... ._......DATE ..........-.... ._----..._.......... <br /> ....__, <br /> ADDITIONALCOMMENTS ..-............................_:_..._...--•------------------..,......---• -............._.-• ...... ----- -•--- -----------::.._ ---. ---------- <br /> ------------------- <br /> ..-•----••-- ------------•. ---...............-- -----...,._-------------------------------------- - . . ....................-----......... ------------- <br /> .................. - - --- -..... ----.. ............ -------- <br /> ------ <br /> - ................ <br /> ...._..... ------------- <br /> f""1'i .a <br /> Final Inspection by: .._._A4�� <br /> `f DtSte ............... <br /> SAN.JOAQUIN LOCAL HEALTH DISTRICT:. _ <br /> -7/723 114 <br />