Laserfiche WebLink
FOR OFFICE USE: .. 1 FOR OFFICE USE: <br /> --APPLICATION-FOR SANITATION PERMIT <br /> ---------------------- - :------ <br /> s '� Permit <br /> [Complete in Triplicate), : <br /> d'. <br /> ----------------------------------------- <br /> 4 Date Issued_ . _7 <br /> _.._.____.__ This Permit Expires II/Year From Date Issued` <br /> ' <br /> Application is hereby made to the San Joaquin Local Health;D str ctt for a}permif to construct and install the work herein described. <br /> This application is made in compliance with County Or�'initi ce"Nos54:9.dnd existing Rules and Regulations: <br /> JOB ADDRESS/LOCATI,ON .---. •_ l-.C.�.>tyj���[llJ CERACT-------------------- <br /> Owner's Name. � ylr� ' = ----------- Phone - <br /> 34b <br /> Address----- ---- ----- -G!1��-- - j .Cit ----zi ---- <br /> - ------------------------ --- <br /> cc - - QQ <br /> Contractor's Name-------------- --------- - -- _i_d ----------- ------License #�S�-3-�3----Phone--���-___� _-- <br /> Installation will serve: Residence Apartment House❑ Commercial ❑ Trailer Court❑ <br /> : Motel "' Other--- ----------== - = ? <br /> �Garba e.Grinder_____________Lot Size______l_ _ <br /> Number of living units:__'_-. ._t______Number of bedrooms'____ ____. g -------------- -----------------_-_-_-___--_-. <br /> Water Supply: Public System and a e 4 -------------------- _ -----_ -•--------------- <br /> ----------------------------------------------- Private <br /> s Character of soil to a depth of 3 feet: 'Sand 0 t 'Silt❑ Clay ❑ Peat[] Sandy Loam 0 Clay Loam r f <br /> I <br /> Hardpan Adobe ❑..4-j Fill Material-- --------- Yes, type---=---------------------------- , <br /> (Plot plan, showing size of lot,Joation of sysii;� in relay oit n to wells, buildings, etc. must be placed on reverse side.) <br /> G ,ss-mow`� :. - i:. �1.. � -r- +�.[..� � �� a <br /> NEW INSTALLATION: [No septic tank or seepage p.it perms ted if public sewer is available within 200 feet,) ¢ <br /> PACKAGE TREATMENT [ l SEPTIC TAN _ , Q Size` - '_______________'___________ ____Liquid Depth._ ----------- <br /> Capacity <br /> _________ <br /> p Y� :V `'-- YP, ��cf--�- L:d�trG�._�__. .No.,Compartments Zy-`---------------- <br /> ' � a tan e°a�arest'rWeil:e_---/gyp � �_ Material=- Fou. � � r <br /> �- -------- ndation_--- 1�-_ -----_ _- Pro . Line <br /> LEACHING LINE ` No of Lines. --------- _,.:_.Length af.each li.ns _.`__./�, r _x Total Length.__-lam ------------ .-, __ W <br /> D' Box .___._Type Filter Material_,_ _ Depth Filter Material---- <br /> Distance to nearest: Well----------- - f-----------Foundation--- -----___---Property Line--F,---,t'___ 1--- <br /> t 1 r. : � � k_ . .....r. . R <br /> SEEPAGE PIT X Depth--- --------� Diameter__._.. -____ Number --------------- Rock Filled YesX No <br /> r TableiD�e,Pi.h. t = r Rock Size <br /> -- <br /> ----- ---- a �l//i <br /> ' <br /> # r <br /> 'Distance to nedrest: Well_._____ .___________________________Foundation._.____!°_ l._.._.1_.Prop- Line_.__J�_ {-___.__-:__ <br /> REPAIR/ADDITION (Prev..Sanitation Permit#_ p,l __________.Date__. __.______________________________________) <br /> = = € <br /> Septic Tank (Specify Requirements)- � _�_.%.._.S°tL�' �¢ �R� �� fl�' �� SP�i�.I. <br /> ------- <br /> I - <br /> Disosal Field.(Specify Requirements)-- -:-_ irl3 �Af� /��e------/r/J_Tf/J _ �—' I ; J <br /> _.. <br /> ---------= J---- -=.. -- --- r-------------- _ I'- -------------------------- <br /> (Draw exisfin and re--uir'ed addition on reverse side) <br /> 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 Regula itions of the San Joaquin Local' Health i)ist;ict. Home owner or licensed agents <br /> signature certifies the following: <br /> "! 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- subiect to .Wqr ),on's mpg sation laws of California.'; <br /> I _ <br /> Signed :Owner <br /> er <br /> t � . . <br /> BY - _ =----- ------ ------------ ----- - -- ----- ------- ---------- ---------f-------�`---------------- -------- <br /> __ Title <br /> ( ) �. . r .. <br /> If other than.owner <br /> z . . FOR DJEPARTMENT USE ONLY , <br /> APPLICATION ACCEPTED' BY------ ! ---_--- ' - <br /> - - ------ DATE.-.�� <br /> DIVISION OF LAND NUMBER-------=----------------- - - DATE. -' <br /> --------- <br /> ADDITIQNAL_COMMENTS�_------ , " ------=------------------------------------------------------ ----------------------------------'--------------------# <br /> . r r< r. -. # <br /> ------------ # ==p'y"i `x I 'f � e4 V.f . <br /> --------------------------------------U -------------------------------•------- ------------- <br /> --------- ----------------------- - - - ----- <br /> Final Inspection_by___ � �_ f <br /> 1 _ :� == ., Date <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 2F677 REV. 7/76 3M <br />