Laserfiche WebLink
r iJf�Ji �}ljV//� *•' !]�,�7�J• !`Vlf �l��I,//Jr! FOR OFFICE USE: ` <br /> FOR OFFICE USE: APPLICATION FOR SANITATIOIAPRMIT <br /> --------- U 9 197 ermit <br /> [Complete in Tri ate 9 <br /> -------------------- ------------------------------------ /V JCA Date issued__...�t�--�_� <br /> This Permit Expires 1 Year Fi 14 <br /> C <br /> Application is hereby made to the San Joaquin Local Health District for a permit to co sttrr gand,install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules andRegulations: Y •� __ <br /> -----.CEN <br /> f OCATION_...:__J S _ --------------- '`- US TRA <br /> S � <br /> JOB ADDRESS/L �- _----' - � <br /> a <br /> Owner's Name_ --- --- ---- ---- one. <br /> Address_. ---�---; -- -------- tY - ----------------------- -.---- <br /> • r, <br /> i.� �a.0Zi-- <br /> . . <br /> I , ' _ 'License #c �S7 1 orZ. w <br /> Qom`� e�4 �- <br /> Contractor s Name., ?' - ''� = <br /> n ^-` <br /> Installation will serve: Residence �/Apartrnent Hous Commercial ❑ Tra ler court ❑ j <br /> t . 3 Motel-❑ Other - --� ---------- <br /> Size, <br /> , <br /> Number.of..l,ivin units:-- ----- Numbe - /` '--- • - --- - <br /> l ` r of-bedrooms �.Garbage Grindox ----- Lot Size-... <br /> ' Pnvat <br /> =... <br /> Y and'name _-- e <br /> Water-Supply: Public S stem -_-------------------_ ----- � �-, r� _�-� <br /> Character of soil:to a depth of 3 feet: + Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam 1 �.. <br /> 5 .. . <br /> ,f <br /> . .. - .If yes, type ----------- - '.---------- - <br /> � � Hardpan ❑ Adobe ❑ � Fill Material.....____..- <br /> (Plot plgn, 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 available within 200 feet,) <br /> PACKAGE TREATMENT [ } SEPTIC TANK j�}� �rX - - - ��-- ---- ------ <br /> PACKAGE .-Liquid Depth.-- _--- -----`--- ' <br /> Size `=r 5 - q <br /> ,. r" I <br /> CapIro <br /> acity /.QUO TYPe Ma#eriaf------------------------' o. Compartments <br /> r U <br /> D.istance'to riearest:.Well,_.� -_ =--- -~- ---- Foundation-----1-------------=-----Prop. Line_._1-----•--;------ <br /> r r . <br /> ac 7 <br /> LEACHING LINE; ,j''1' g' / X= h line.. _ ------:Total Length --- .G=------- ------------ <br /> D' Box.ly.__._T e Filter Material____1r.__ . .. rr / # <br /> No, of.Lines._.__....-..----=-- --�--„--Len th of eac <br /> YP Depth Fitter Material- ----- ------=------ <br /> _ 1. / -- s <br /> to nearest: Wel!_;_//�.--- ------Foundation-----�-----------------Proper ty Line---- ----------------------- <br /> Distance (f <br /> De th- r --Diameter-=--- -___---Number-----------z--------- Rock Filled ;Yes No ❑ <br /> SEEPAGE PIT ("j' p ► . �y. <br /> Water Table Depth Z_ ------ --------- ---=-----------------Rock Size. <br /> SOD' <br /> ._ �Q Prop. Line <br /> - Foundation. --- ---- <br /> Distance(to nearest: Well--- ------________ __ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#-----------------------'--------------------.- <br /> -----Date------------------------- - ---- ----- <br /> Septic Tank (Specify Requirements)------------------------ - ----------- ----------- <br /> Disposal Field (Specify Requirements)--------- --------- ------------------ ------------- _--._-_.---------- ---- --------------------- ... <br /> r <br /> ---------------------------=------ ---------- - ., <br /> --- <br /> ---------------=---=--------------------------=---------------- --- <br /> ----------------------------------------------- <br /> - <br /> -------------- <br /> i <br /> + (Draw existing and required addition on reverse side) !� <br /> I hereby certify thatl 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 /> Ir signature certifies the following: : <br /> 4 "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such inannei• as <br /> to become subject to .Workman's .Compensation laws of .California.'.' <br /> Signed------------- = - -- -------- - - ---- -------------------------------------------------- <br /> -Owner ey� <br /> Title <br /> .. <br /> (if other than owner) <br /> OR PARTME T U ONLY y i <br /> -- - ---- ------- --- ----- -- <br /> DATE <br /> DATE..__ <br /> �•- - _ DATE ---------��-- ----- <br /> APPLICATION ----- <br /> ACCEPTED BY._ .----- - --- - ' <br /> DIVISION OF LAND NUMBER: --- y'----- : <br /> -- ------ <br /> ADDITIONAL COMMENTS----------- ------ - ------------- ------------------- ------- <br /> ----------------------------------------- - -- <br /> tI -------------------- ------------ <br /> ---------- ----------------------------- ------------------ ------. --- -- ---------- -..------------ --- <br /> .j r • --------------------------------- <br /> •. _ __•--_•-••.............. <br /> _•................................••____ 1 •-- --_ -- ----.-------.._._. <br /> ` ----------- - -------------- - <br /> ...................... ...• - ___ -__••-____........___..-._.....__... ------------------------------ <br /> --- <br /> ___.....-___ - <br /> Date --- <br /> Final-inspection by,-::P J-�- --�- -�- F&5 21677 REV. 7/76 3M <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />