Laserfiche WebLink
FO OF CC USE: FOR OFFICE USE; <br /> APPLICATION FOR SANITATION PERMIT <br /> i x <br /> ._- Permit No----7�- <br /> `- � �f, (Complete in Triplicate) <br /> ------ - �-w. . Date Issued_fy--� ��2 <br /> == �. <br /> ' i�- ----- This Permit Expires 1 Year From Date Issued <br /> Applications hereby made tolthe San Jodquin Local' Health District fo`r°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 /> 4 _ <br /> Qi <br /> -.--E---CENSUS TRACT -------------- <br /> JOB <br /> . ------ <br /> JOB ADDROCATION ------ -- - - <br /> ---- <br /> Owner's Name--------------- f -- ---- ---- ---- -----= ---- <br /> .-TPhone <br /> -zJ� ----------- <br /> Owner's <br /> -. <br /> Address---- y ----- ----- ---- -- - ----- --- -- <br /> C tY <br /> ------------- <br /> e i Zip�.� � .��. <br /> . A . .,..y... �I .� - -------- <br /> - --.- -- <br /> Contractor's Name - ---�--SOTv1 License - � Phone- <br /> i <br /> 4. <br /> Installation will serve: Residence' Apartment House Commercial E] iTrailer Court Ll N. <br /> � <br /> K i Motel ❑ Other-------------- #. __...... _.�._-:• F <br /> s zl I ---- --- <br /> '! --_Number of,bedrooms --------Garbage Grinder- Lot,Size.-.- l��C� O <br /> Number of living units:... L...... <br /> Water Supply: Public System and name-- --- - - _ � --r' � t � Private `�*:• <br /> -_ ' <br /> Character of soil to a depth ofj�3 feet: s Sand ❑ Silt❑. Clay ❑ Peafi Q Sandy Loam ❑ Clay Loam ❑ <br /> r Hardpan 75,� Adobe ] Fill Material ;-_--._If yes, type--_'_ <br /> (Plot plan, showing size of lot, location of system in relation to.wells, buildings,.etc. must be placed on reverse side.( a <br /> F. <br /> NEW INSTALLATION: '(No septic tank or seepage pit permitted if pubic sewer is available within 200 feet,( <br /> r <br /> PACKAGE TREATMENT [ ] SEPTIC TANK 1�G], ® size-----:--- -- /--�-- _------=------`-- Liquid Depth-'_ ...- ----- -- <br /> �-f Material.._- _!z-L -'-No. Compartments---------- ------------------- <br /> -----, CapllpcitY-- ----- -----= -°TYPe-----:-------- � r <br /> { U. f _Foundation.- Pro Line <br /> Distance to.nearest: Well._„l{�- ------ = �� -- P <br /> LEACHING LINE.- No, of Lines____-,.5„_ :._.:-------.-:Length of a ch line-------- ------------- -.Total Length --.��-�-�-------------------c-- <br /> D' B"ox----- TYPe Filtern <br /> . Material. -- ------ --- Depth Fitter Material.--------�-- ----.------- '---------- - <br /> i . <br /> •Distance-for+earest: Well----1(TV_ .-----------Foundation.---f-�-j--------------Property Line..:-�' ---- i---�}-�---� <br /> SEEPAGE PET-� [ Dept• x.. Rock Fil'led. . -es- No❑ <br /> th-Z.� "� Diameter-: Number__---- <br /> t Wat r Tdble Depth �i -- -- ------Rock Size_--Y ��( �r <br /> Distance to nearest: Well-_---�___�-S-`�------- ----=-=------Foundations.—"__------------------ rop.' tine =--. <br /> -- <br /> . j _ .�« Date--- `------------ ` '-------------1 <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.: _'-.:''--- '-------- <br /> Septic Tank'(Specify,Requil6e `enit) - �°--�--= =-------- -------------------------------------- --------- <br /> i. <br /> Ir --- __"^----�..-.,:'�-t_' --"`�---- -- '-�--------e•_. <br /> Disposal Field (Specify Requr'rements)_------ ------ ------------------ - --------------------- <br /> --------------------------.. <br /> F (Draw existing and required addition an reverse sideM <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County <br /> t Ordinances, State Laws, and Rules 'and Regulations of'the San Joaquin Local Health District. Home owner or licensed agents <br /> 0 signature certifies the following: <br /> i "I certify that in the performance of�the work for which this permit is issued, I shall not employ any person in such enannerpas <br /> to become subject-to Workman's Compensation laws of California." <br /> & - ---- - --- <br /> Signed--- r - = Q_ N _ - <br /> f �' '` <br /> t= - -- --- Tatle <br /> [I o;her than ow' ry } , <br /> FOR DEPARTMENT USE`ONLY' <br /> APPLICATION ACCEPTED BY.-__ -- .:- DATE--------'-----" --,----:--- ---------- <br /> : 4 <br /> ----------------DATE.-- -/�--- <br /> DIVISIONOF LAND NUMBER --------- ------------- -------------------- - ------=-==------=-------------- ------- <br /> ADDITIONAL COMMENTS---N--------= -- ---------------:------------------ :------------------------------------------- <br /> - - - = <br /> # �M ---- -------=----------------- <br /> � - <br /> ------------- --------------------------------------------------------------- <br /> IM ------- -------------- ---------- ------ ----- <br /> - ------------------------- - - ------ <br /> IN <br /> ------------ - <br /> ----------------- - -- <br /> ----------- - --------------------------- <br /> - - <br /> ----- ------------ -- -------------------- ------ <br /> Final Ins action b �.. ----Date-. f ; <br /> EH 13 24 SAN JOAQUIN LOCAL EALTH DISTRICT Fas 2�bn REv,_��" <br />