Laserfiche WebLink
FOR OFFIC U FOR OFFICE USE: <br /> ��V <br /> APPLICATION FOR SANITATION PERMIT <br /> -------•----------- -------------------------------------- (Complete in Triplicate) <br /> Permit No...... <br /> --------------------------------------------------------- <br /> Date Issued--- =_ /-_.7111�11 <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._.. r�----__Aoc U-3T----o 5,ah I we-#- C,_v fs CENSUS TRACT--------------------------------- <br /> Owner's Name-------Mc,_*----------- ---------------------Phone--- <br /> Address------3pe_OOU------- --------t el-----------------------------------------city----TYAGy- ----------Zip----------------------------� <br /> Contractor's Name---------- <_ /v71SvAr_y 4 5'w-------------------------------License #_/0-S'84 Phone_5'••�3 -�2/�'-- <br /> Installation will serve: Residence R Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other------------------------------ ----------- \ <br /> Number of living units:------/_--------Number of bedrooms_A-------Garbage Grinder------.-----Lot Size--------------------------_._---___-._._____________ <br /> Water Supply: Public System and name-------------- ,-----------------------------------------------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam L <br /> Hardpan ❑ 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.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) a <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-----------------------------------------------------------Liquid Depth--------------------------- <br /> Capacity 0---------Type-�P-C,ssT-.Material----'Co/vc.---------No. Compartments------A-----------------------/ <br /> Distance to nearest: Well-------------------------------------------Foundation-__.RA_�_________Prop. Line___S�_____________ <br /> LEACHING LINE [ ] No. of Lines_ -Tey__ IF-dLength of each line---A0_'X_-20_"___.Total Length ____________-_-tij <br /> 'D' Box -!--.--Type Filter Material --------Depth Filter Material___�c v�--------------------------------------------------- <br /> . 1shince <br /> far earaw - <br /> f=ovn lcffi _ ---- ----------- Property 0i--------------------------- - ----- <br /> SEEPAGE PIT ( ] Depth- -----------_Diameter--------------------Number_----------------------------- ❑ ❑ <br /> Rock Filled Yes No <br /> WaterTable Depth---------------------------------------------------------Rock Size------------------------------------------------ <br /> Distance to nearest: Well-_---------------------------------------Foundation--------------------------Prop. Line__________________________. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#___-_______________-___-__________-__________-Date______________________________________________) <br /> SepticTank (Specify Requirements)----------- - ------------------------------------------------------------- ---------------------------------------------- --------- <br /> Disposal Field(Specify Requirements) _-_--_______. <br /> - ------------------------- -- ---- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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: <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 Compensation laws of California." <br /> Signed---- c_, MT/So SdIV-----------------------------------Owner <br /> BY------- -------- <br /> ----- ------------------------------------Title------------ ------------------------------------------------------------ <br /> o er qn owner <br /> FOR DEPART T USE ONLY <br /> APPLICATION ACCEPTED BY_ _ DATE -------------- <br /> --- -------- <br /> DIVISION OF LAND NUMBER----------------- - ---------------------------------- <br /> DATE----------------------------- <br /> ------------------------------------ <br /> ADDITIONALCOMMENTS---------------------------------------------------------------------------------------------- --------------------------------------------------- --------- ----- <br /> -------------------=--------------------------------------------------------------------- -------------------------------- ------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---- <br /> - <br /> --------- ------ <br /> Final Inspection by:------ --- '`------------ -------------- ---Date.. " -7 <br /> ------------------------------------------------- <br /> --------------------------------------- --- --- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3M <br />