Laserfiche WebLink
FOR OFFICE USE:` I i APPLICATION FOR SANITATIONPERMIT FOR OFFICE USE: <br /> ..................•-----...------------ _ <br /> (Complexe inrTriplicate) Permit No....7 :�7-2 . <br /> ' Date Issued_-�.""Zf._7f <br /> ............................ ........... This Permit Expires 1 Year From Date Issued <br /> rl� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> .......__3.. e <br /> JOB ADDRESS/LOCATION J --._ - <br /> `� P� �p44�r.�ENSUS TRACT.----------- ................... <br />' O.wner's Name7b?.!.1f.W 1.� .. :. .- / Phone s 8G6- <br /> Address---9Ss6. ;..._.._. <br /> FF ._i..City. -- ------------- ziP ' D.tE�..:-•- <br /> Contractor's Name......................I' License #----•.._._.....--..._--......Phone_ <br /> ----------------- ---------- ... .E <br /> Installation will serve: iResidenceX Apartment'House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ 'Other <br /> Number of living units:.........._:... .aNumber of bedrooms.�_....Garbage Grinder-------- <br /> Y <br /> 311 .. .. ...... ...... <br /> Water Supply: Puklic Sysfem and'I'name__.... ._..•_..... . vat <br /> ❑ .y 0 Peat ❑ `Sandy Loam ❑ Clay Loam ❑ . ^.:...-.Pri a <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt Clay \� <br /> Hardpa�F❑ Adobe ❑ Fill Material.. ___. ... If yes, type........... .................. l� <br /> (Plot plan, showing size of lot, l btion of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (Nosepltic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEO TIC TAMC J J Size ............:------------------ <br /> -----------------------Liquid Depth-----------------.-.---- <br /> - <br /> pP <br /> � . . <br /> ------ YPe. aterial.....................::...No. Compartments.... -^ ----- <br /> ------ <br /> Distance, <br /> -- - <br /> ll <br /> Dtanetie ... ----.-.Foundation./- ......Prop. Line.6117 <br /> i -... <br /> LEACHING LINE ( J No. of Li'nes..:�:...°___-Mr-_....Length of each D..7jL`_--. __-Total Length.... ' ........... - <br /> 'D' Box_IL-:7 ;Type Filter Material Depth Filter Material.^;L <br /> Distance to nearest; Well.-. . .........Foundation---- 'y............. Property Line.-..-,?!.�4..... <br /> �.. .- . ...---.. i <br /> SEEPAGE PIT ""Y[`J Depth....: ...... Diameter.......... .....-.-Number-:------------------- Rock Filled Yes ❑ No <br /> .:... <br /> „p rWater Table Depth---------- -•--------------------- ------._,.--.Rock Size-------- ..... ...- -------------•=............ <br /> Distance„ o nearest: Well.--------• ----- <br /> _ Foundation..........................Prop. Line--------------•--..... I <br /> REPAIR/ADDITION {Prey. SanitatiJJon Permit#.:............. <br /> ---- - ------- -----Date.-------..-• - ------..-....---------� <br /> Septic Tank {Specify Requirement.). .... ----..1...-•-•-------.-.-- ..... ------------ --------- --------- ----- <br /> Disposal Field (Specify Requirements(...--- ........I------- -•-------------- ---- ------........................ <br /> = ----------•- --------• --------------- <br /> :I, <br /> ........................... Y <br /> I : <br /> (Draw existing and required addition on reverse sidel <br /> I hereby certify that I have prep&ed this application and that the work will be done in accordance with San Joaquin County <br /> 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 subject toan i Compensation laws of California." <br /> Signed....� .f<s t.cC cid . <br /> �- -.................................-......Owner <br /> BY '------------ ------------- .----- -Title.--- .................. <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- DAT( �dtl� � <br /> ----- _---. --- <br /> DIVISION OF LAND NUMBE .. _Ih __ ........DATE.. ----------- - ---------- <br /> ADDITI.. COMMS..T�S ...�M. -. _ ` ` - . ......................... <br /> - -..... <br /> �__t&,> <br /> ...-• -•--- '---------- -------------- - --------- -------------- ------.....- --------- ----------------------- --------------...------ ._........... <br /> . . ryFinal inspection by -------------------------- -- --- .......---—...Date `. `� � <br /> IN 13 i4, SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br />