Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------------- -- ----- <br /> ------------------------- <br /> = <br /> �' - (Complete in Triplicate) Permit <br /> Date Issued_&'.-. -_�$� <br /> ------------------------------- --------------------- - 't <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 Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION.- --- 1/C/:..------- -- -��xA �-=r ...:._h CENSUS TRACT. _ = <br /> Owner's Name--.---- : -CX i-<- - - - ---- ---------- -------- = = Phone <br /> Address-----------------oL� Ir/' / � City � -�- d <br /> zi <br /> Contractor's Name - -- --11 -- License # - Phone---------------------------------- <br /> V <br /> ----- - - ! <br /> t will serve: Residence Apartment House. 4 <br /> Installation p ❑ Commercial ❑ Trailer Court ❑ <br /> , <br /> Motel E] Other...... 5 ;. Y.... <br /> Number of living units:_-_ -'------Number of.-bedrooms.-3---Garbage Grinder_'_. _-Lot Size. �C� �.�-- ---------__-.-- f <br /> Water Supply: Public System and name----=------------------------------------ ---. ------------------------------------ --Privatef <br /> Charpcter of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ =Peat ❑ Sandy Loam E] Clay Loam ❑ <br /> ` <br /> Hardpa - _. <br /> Fill Material --�+If_YeSjt?'Pe" <br /> P ❑ ' f <br /> [Plot plan, showing size 'of lot, location of system in relation to`wel[s, buildings, etc. must be`placed on reverse side.) <br /> NEW;INSTALLATION:' septic'f. � r !r is available'within,200 feet,} , <br /> p7 - <br /> PACKAGE TREATMENT '[{ o. SEPTIC#TAN�Kr [se ge `'—" Size:: ub ` ' ._.��: *__;.Liquid Depth -_-------.. <br /> p P !� <br /> l <br /> Capacity. � - —_ No. Com artments--=-------------= ----- <br /> -���-=----Type__ _ _Material---- P ems <br /> %i Distance:to nearest.: Well------.__. r���(. ___,..._Foundation r .____;_ Prop. Line. <br /> LEACHING LINE [. No. of Lines.:_.____1 Length of each line_ _�.`- -.-...Total Length ,��.. <br /> !' D' Box_ ......Type Filter Material------ 1�Depth Fil#e€Ma#er�I `.. -....___. <br /> ,lti j Distances to nearest:-Well : ,G Foundation �^�.Property Line. -- ------ -------- <br /> _. r <br /> SEEPAGE PI7 .[ Depth_ Diameter : _ .a_.--...Number_- --- N <br /> Rock Filled Yes o <br /> Water Ta'ble Depth-. a / ': Rock Size• .__f__---- <br /> --- <br /> � <br /> =- <br /> F Distance t6 nearest: Well.'_.____;_ _ - ------___-------Foundation._______° Prop, Line_=_ __- <br /> REPAIR/ADDITION (Prev' Sanitation Permit#------------------------------------ ------------Date------ -------------------) P <br /> G 'Septic Tank (Specify Requirements)---.- __. ._ .._ <br /> - ------=-=--- ---------------------=----- ------------- <br /> Disposa[ Field (Specify Requirements)'----"---------------- --- ------------------------------------------ -------------------------- ----- ------ ---------------------- <br /> A <br /> ---- ----------- <br /> ----------- -----=-------------------- <br /> -------- ----:-------------------------------------------- ---------------------- .--_ -------- .- --------------- ------- --- -- ----- ---------- --- <br /> i <br /> ---- --- .--- -- ------ <br /> r - (.Draw-existing and-required addition on reverse side) +, _ <br /> 1 hereby certify that I have prepared 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: I , <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 to .Workman's Compen ion Jaws of California." {� <br /> Signed-----�-----=--- ----- ----------------- ---- ---- /7- -------Owner t� <br /> BY :--------------- ----------- --- -- --------------`--- .---- - --- - --------------- -----Titleµ�- --- -- ------------------ ;---- ---------------=(If other than owner) .... <br /> FOR DEPARTMENT USE ONLY F <br /> APPLICATION ACCEPTED BY---- ---=-----=-- --- - -DATE.-- - <br /> DIVISION OF LAND NUMBER ------`------- ------ - :. <br /> �- ---- ---------------DATE---- ' <br /> '-------------------------------- -� i <br /> ADDITIONAL COMMENTS------------ ---- - <br /> ' ---------------- ---- : . <br /> ------------------------------------------------------------------- - ---- ----- ------------------------ -- ----- ----------- ------------------------------ --------------------------------- <br /> = ------------- --- ----- ----- <br /> J <br /> Final-inspection by:---.-------------"=-------� '-------� l --------- - � �------- ---- ------ F --------- <br /> ---Date-'-- - -� <br /> EH 13 24 SAN JOAQUIN LO6AL HEALTH DISTRICT rss 21677 REV. 7176 sm <br />