Laserfiche WebLink
�• 'R� � <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT �-��-�3T Permit No.. `!7 <br /> --- <br />` ---------------------------------:------------------- (Complete in Triplicate) `� <br /> -------------------------------------------------------- Date Issued T-o�_J_' ?? <br /> ----- <br /> _--_- This Permit Expires 1 Year Fr.m Date Issued <br /> I / <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 <br /> Ordinance No. 549 and existing Rules and Regulations: <br /> L{-7 =--- ----------------------------------- <br /> -----..CENSUS TRACT. --- -- - .. <br /> JOB ADDRESS/LOCATION <br /> ----------- <br /> y � g <br /> Owner's Name _ ---- - ----.Phone-9-31f <br /> �� . <br /> i • �-- ---` r city--- <br /> C -.. ._ -- --- -----------/y�--- ---- ----- <br /> 5-- -- --------------- .. IE 1 <br /> License #_ .-_ Phone_�P --- <br /> Contreactor's Name. ----------- a <br /> Installation will serve: Residence ❑- Apartment House 0 Commercial ❑ Trailer Court ❑ <br /> MoteL_I—"Other -- - --- - -- -- --- <br /> . � <br /> Nulmber of living units:------- Number,of.bedrooms'._�-----Garbage..Grindw - -- Lot,S' e -- 6 -x-�•�'�' - - -- -- <br /> Private <br /> Water Supply: Public System and.name----`-- --------------------- --------- _-- - E <br /> a ❑ <br /> ' .,�Sr�❑� -Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ `Clay, Loam ❑ <br /> Character of soil to a depth of 3`feet' aA. <br /> nd SFill Material_- _.__.__Y.If es, type________________________________ r <br /> .Hardpan ❑ Adobe '� Y <br /> r {Plot plan, showing size of lot, location of system inVelation to'wells, buildings, etc. must be placed on reverse side.) <br /> b', _.. ,' . <br /> NEW 'INSTALtATION:l ..(No septic tank'or s�Tepage p_it permitted if purblis sewer is available within 200 feet,) �� J <br /> f Liquid Depth._ ------------1� <br /> PACKAGE TREATMENT ( 1 SEPTIC TANK'�Q'� �JG��itlSfSize--___'-.. ----- ----- --------- ---------- -- - -- -- <br /> Capacityf_• Types" `t�rc-- 'Material/�� ��jR. '_No. Compartments-- -----2�' ---- --- <br /> ' ' ; _ Foundation '------------------------Prop. Line_ <br /> Distance to neared t Well___t~}: .•titin <br /> of Lines.�--- '--'--- .-- a' L�ngth of.each line,------- --------- ----Total Length --------- ---'----- <br /> LEACHING LINE. ( ] No. 4 '. . <br /> D� Box. . :. T e Filter M --------------------- Filter Material_ ._ = - _' <br /> yp.I + ;. <br /> ! I Distance totnearest; Well--.---------------------------Foundation------.----------=----------.Property Line------------- ---'---------- --1� <br /> ; a _ R Y ❑ N <br /> t ' Rack Filled es o} <br /> SEEPAGE PIT C 1 Depth Diameter '- -----Number <br /> — ` t Rock Size <br /> Water Table�epth f., ------------------------------------- <br /> ------------------ <br /> 14 <br /> 3. 4 .- p ;` ' tom. ' <br /> Di'st.ance to nearest:Well - { `Fr - r* - ._,_ __. ` Prop. Line----------------------------- <br /> Foundation <br /> „�� a ': <br /> .. .�N"{ t `? . =.Date --- `-----1 <br /> REPAIR/ADDITIOPrev:FSanitation Permit#-_--- .-------`---------------------- F Y_ j <br /> Q� <br /> k Septic Tank (Specify Requirements)-----.----- rQ. $ __P�*!C -- <br /> Dis osal Field (SpecifyRequirements)_ --------------:--` ------------ ---------------------------------- ---------------------- -- <br /> p ----- -----q--- -- ----- - ----- ------ ------ -- ----- ..------- -----------------------.- ------------------------------- <br /> --- ----- - - <br /> Q --- <br /> � - - -- -Draw existing and re --------------------------- ---------- ---------- -------�:.,., ---- . <br /> ha <br /> �- - - ��-�-- ---��- -�- - -- � �- -- --- •• ( g qulred addition on reverse side) ' <br /> l 1 herebycertify that I have prepared this application and 'that the .work will be done in accordant with San Joaquin County <br /> � °s "--' <br /> Ordinances, State Laws, and Rules and Regulatidn's�f 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 manners <br /> Ito 'become..subject.to Workman's .Compensation laws of California." <br /> Signed r Owner I <br /> _ 1 <br /> ! Title1. - - - -- --------------- ------ <br /> ------------ <br /> -- - <br /> --- - -- ---- <br /> (If other than owner) " <br /> 4 iFOR•DEPARTMENT USE ONLY t --- <br /> h `_ DATE <br /> APPLICATION ACCEPTED BY_'------ ---- , -----:.---/'' -------- <br /> DIVISION OF LAND NUMBER.-------------=-------------- <br /> r YDATE `----=------------ ----------- ---------`-- <br /> ADDITIONAL COMMENTS.-.-_---- --------------------------- <br /> I <br /> ----- <br /> ► ----------------------------------------- --------------------- <br /> ---------------- ------- ---------------------. ---------- <br /> -------------- --------- ------------- --- <br /> --------------------------------- <br /> - <br /> ----------------------------- __ Date ---- - ------ <br /> - -- -- -- --- - - <br /> Final Inspection by:- <br /> "ti x i�1 � � "'-i-'�'. � �--F�677 REV.7/75 3M <br /> EH 13 24 SAN JOAQUlN CAL HEALTH DISTRICT <br />