Laserfiche WebLink
M <br /> FOR OFFICE USE: %E 71 7 �� FOR OFFICE USE: <br /> .� APPLICATION FOR SANITATION PERMIT /-� f G c <br /> E ------------- % Permit No. <br /> k - <br /> ------------------- <br /> y (Complete in Triplicate) _ <br />�t -------------- --------------------------------------- Date Issued- - -r--�--------- <br /> . _---------------------- <br /> ----------- ------- This Permit Expires`■�1 Year From Date Issued _- <br /> Application is hereby made_to_the_Son..Joaquin*L-ocal-Health Distritt fora permit to.con struct•:and:instdII th-ework herein described. <br /> This applicdfion Fs_::?ale in`cormpli-ance-with-County-•Ord.inance.No -549�pnd-ex-isting-'Rulles=and-RegulationsR <br /> /ss CENSUS TRACT..... .... .. ..... <br /> JOB ADDRESS/LOC TION ._6_1 : _ --- ' ------- <br /> Owner's Name-- ------- - -- - �-------------------- ------------------- - - ------------------ <br /> - <br /> -- - <br /> -----------.Phone---------------- --------------- <br /> i 4 -_ ----- ---------- ------- <br /> Address----- -_ __-- - -- ---- City Zip � .� <br /> i . ).. �� r y ices #- ._. fd Phone_ ? <br /> Contractor s Name.E �.._ � �f <br /> Installation will serve: ; esidence 5J--Apartment Houser❑ Cor n erci 7Trailer Court. ❑ Y i <br /> . Motel ❑ Other----------------' --- "`----- -- <br /> 1 <br /> of living units:__.._...- _____Nurriber of bedrooms-_ -.__.Garbage Grinder--.._-----;-Lot Size_...___--. -.. ---- --------- <br /> ,,Number <br /> -- ---._ ----------------- <br /> Private �� <br /> Water Supply: Public System and name--- ..� .`_4�._-�-- - �_-: :---- --- ------ ------- -• -�-- <br /> Character of soil to a depth of 3 feet: - Sand ~.Silt ❑ Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ <br /> Hardpan E] Adobe❑ Fill Material___- -_..If yes, type------ ____°-------------- <br /> f <br /> ,.. (Plot plan, showing size of lot, location of system in relation to:wells, buildings,.etc.�must be placed on reverse side.) t <br /> i NEW INSTALLATION:' '[Nof septic tank or seepage pit,permitted if public sewer is available within 200 feet,) <br /> Q4_ <br /> . <br /> , �Q d <br /> PACKAGE TREATMENT- [ ] SEPTIC"TA`RK j- _S 76,E ---_max-` --Liquid Depth : --------_----- -- <br /> Ca aci ��t� �� -`- -) --------- <br /> p ty�, �lJ Re 'Material I -- '��No. Compartments ----- <br /> l7istance.to nearest.: Wel1_,S�-�_____________!___-- Foundation-44C -�_.__.- ,__ Prop. Line___ ._ _�---------___. <br /> t C , . <br /> LINE- k') No. of Lines ,.3 Length of each line.___ -__._ _do Total�L ngth . � -- <br /> y �p s - # C <br /> LEACHINGa Filter Material ._ __. - Depth Filter Material 2R_��. ._:-. <br /> D' Box _�.. T � . . . ., r <br /> Distance to nearer } <br /> : -------------- <br /> • t: Well-----;------ --;--�--Foundation-- ------;__..-; .. .. -,P�perty Line---- �.r# <br /> SEEPAGE PIT ` .[ ) Depth----! Diameter_ ------------ <br /> Water <br /> -- --- f Rock Filled . Ye No ❑ <br /> ----Number. ------ <br /> r .. ,.. .. .i.. - -- Rock Size - <br /> --- <br /> Water Table Depth _ � <br /> f r Distarice'to nearest: Well-. ------- ------ _-.-Foundation Prop. Line ______ <br /> ti .Date------- s. <br /> REPAIR/ADDATION (Prev. Sanitation Permit#___.._:'_----_.- - - ) <br /> k �._<_ " - ------ <br /> Septic Tank (Sp ecify.'Requirements)_ `--------------- =-= moi. ° r <br /> '--- ------ ----- --------f <br /> Disposal Field Specify Requirements) ..,__. .__._- _------._-, �- --------- ----- ,-, - ------ 0 iI I ; <br /> ) t ----- ---- ----- - -- - ---- -_ <br /> --------- -------- - ----- ----- -- <br /> ----- -------- <br /> (Draw existing and regi fired addition on reverseside) <br /> I hereby certify that:I Have prepgred 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 I ensed agents <br /> signature certifies the following: y ) f <br /> "I certify that in 'the performance of'Ahe`work for which this permit is issued, I 'shall not employ any person in <br /> manner as <br /> I - - --- - lifornia.'.' ? ` <br /> 5i become subject to ,Workman, Compensation laws foF`Ca <br /> g ;Owner . . -. <br /> ;_.. <br /> BY----- --- - -- --: - Title - - -- - I <br /> 2 <br /> 1 ')Ifother�than,owner) <br /> FOR EP TMENT USE <br /> W LY <br /> APPLICATION ACCEPTED BY.._ DATE.. <br /> DIVISION OF LAND NUMBER..- DATE <br /> ---------------- <br /> ------------------ <br /> ADDITIONAL COMMENTS---------------------- ------------------------------------------- ------- <br /> ------------------ <br /> ----------------- ------------ -- ---------------------------------------------;--- <br /> -------------------- ---- ------------------- --------------------- - ------------------------------------- <br /> ----- <br /> --------------- - , <br /> Fina_ -` " <br /> - - <br /> 1 Inspection _ . --Date ------------ <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT res 21677 Rev. �� <br />