Laserfiche WebLink
FOR OFFICE USE: � - FOR OFFICE USE: <br /> ✓APPLICATION FOR SANITATION PERMIT <br /> ' Permit <br /> -•-•-•-••---------------- -"...-... --..-...__. (Complete in Triplicate) 1� <br /> -------------""____-„----- ......-----_...._ y { <br /> Date Issued_ ------_---. <br /> ......................... .......-.............-. This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with.County Ordinancr. No. 549 and existing Rules and Regularions:. - l <br /> ,��J r:S - --- ,CENSUS TRACT. <br /> JOB ADDRESS/LOCATION.....-�.� ®*��. !�_ ----�---- --- ------------•----•---...---- ” ��a6 <br /> Owner's Name.-.. .-..-. ....... Phone-.. � _ <br /> { <br /> Address_.._ `�Q .....- 1-Vi ."...M714....-- .�_�. �r - ---- -.-. t CL}.. :--- ,"-_- , p <br /> :. ..Name..::'.- ,..-mak.-./ License #... .....--: .Phone.- <br /> Contractor's <br /> Installation will serve: Residence Apartment House [] Commercial ❑ Trailer3Court ❑ <br /> I Motel ❑ Other_.. ------ ----- - <br /> Numyber of living units:.. ...........Number of bedroo S._15 Garbo G inder_A10-,_-_Lot Size---- " <br /> t Private <br /> Water Supply: Public System and name.... .- g1...?/..... - ------- ------ ----- <br /> -- lv ❑ <br /> Character of soil to a depth of 3 feet: -Y�Sand.❑ i!t ❑ Clay*'[]. -.Peat ❑. Sandy Loam ❑ . Clay Loam ❑ <br /> Hardpan ❑ Adobe j Fill Material.. ._-- If yes, type--- <br /> F � <br /> (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 tank or,seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( } SEPTIC TANK } .Sizel. �--- - ----r-- 1 0 ....--Liquid Depth------------------------C , <br /> Capacity.. t " ._ . .t Type-- Material- ...:No. /impartments. // r-- -------- <br /> QiDistance ._.-....._ Prop. Line-_ ---- <br /> stance to nearest: 1Neli-'..._-..._�✓��-.-.--.---.- "- ---- ------ <br /> LEACHING LINE jjQ No. of Lines....: t_L ._:_.-..Length of each line.-- &S,--t ---,_. -"Total Length -. .-----1- �-- <br /> 1re e <br /> � Q' Box------�...--Type.Filter.Matenal .SLsfa1:' t'�epth Filter Material-----...._)8_-�_-�-- --------y --- - - ---" - <br /> -- . <br /> r✓1�,. Distance to <br /> We <br /> ITT <br /> Property Line.....---- •----f!►1r h - <br /> Vr Ar'.ti �v1r. 1 F 17 <br /> �71-, p _- � ._ -/ ..:-�------ ------------Rork Size.. ..:�..� .b----- .-..._ Yes ❑ No � ". <br /> ( Water Table De t�h.�_ _�.�g..Cj._Number---.----�--------------- ----- � Rack Filled <br /> .. � P y <br /> + I pJ <br /> T , r/ , <br /> .. Foundation_.' p.Prop. Line---`�r._.1'�!.c.'� ----- <br />�. Distance to nearest: Well-.--.,___"_!v . - .- -:--- # <br /> REPAIR/ADDITION (Prev. Sanitation Permit#-----------"--- -----" ` " <br /> ...-- -- -------•-.Date-----------•------- --------- -- -----------� <br /> ----._-.... <br /> ... <br /> Septic Tank (Specify Requirementsl....... ........... ... ...__-...... - ... <br /> Disposal Field (Specify Requirements)............. . --------------------- <br /> ------------------ <br /> ----- - l <br /> -----•--•--•------"---......................................................... -- --------,",----- ------.-.......­­------- --------------- ..--- ..._---...---------"------- --------- v.- <br /> f, <br /> -•------•-------------- ------------------" = --------------•----I- ------.------- -------- ---------•--•---------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> k Ordinances, State Laws, and Rules and 'Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: .. <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become h6ject to Wor m Complensatian laws of California.". <br /> Signed. -... - ....... Owner ' <br /> BY ---------------- <br /> - ..Title.. --- ----------,........ <br /> (If other than owner) ! <br /> DE ARTMEN USE NLY <br /> APPLICATION ACCEPTEQ BY__.__.... - 7,� <br /> DATE <br /> a.2 -� ....._.._._. <br /> DIVISION OF LAND NUMBER .............. <br /> ADDITIONAL COMMENTS............ ................ -----------•---- - ------- - - ......... .......... <br /> -------•- --------.,---,""", -,"",. - <br /> k "� ------. ----•------ ---- -------------- -- ------ <br /> ................... ................ "- ------ --...... <br /> -1----------------- ---•------ ----------- - <br /> ----------- -•�- ---- - <br /> Final lnsgect�an 6 --------- Date...-.- <br /> y:...__. <br /> ' F,H 13.24 SAN JOAQUIN LOCAL HEALTH DISTRICT F 'REV-.7/7-e3M <br />