Laserfiche WebLink
q <br /> FOR OFFICE USE: j a FOR OFFICE USE: A <br /> APPLICATION FOR SANIIATION PERMIT <br /> ------------------------------------------------- <br /> ICamplet�=in Triplicate) Permit No..7.7-------------- <br /> Date Issued..- <br /> ________________________ --------------------------------- This Permit Expires I Year,From Date,issued <br /> `r d <br /> 1•r-�- 7 �.�t '� <br /> Applicatiorris 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 /> 21 <br /> JOB ADDRESS/LOCATIO Q ---��'�_/' - __ CENSUS TRACT <br /> 7 <br /> �y <br /> s <br /> OwnersName. - = -----------------=----------------------------------------Phone--- -------------------------- <br /> . i <br /> Ad—dress-- City Zi <br /> ,y.. } --- <br /> Contractor's Name- -- - }1 �_ ( - _ License #_ _ '�' '_Phone_., ��f / . <br /> � , <br /> Address -- 3 _ ��'�: �`" t''._,_.,—. City j ► <br /> Numberof living units:----------------I;Number of.bedrooms_,7�,"k----Garbage Grinde•r,__-C_7" -Lot Size--__-a ---- --------------------- <br /> "Water <br /> ____.___-___.__"Water Supply:-Public System and name-----------7r, = - -- ------------------- ------------- --=. Private,�,�, <br /> Character of soil to q depth of 3 feet.,_Sand_n :Silt 0 . Clay ❑ Peat C] Sandy Loam Clay Loam ❑ i ! � <br /> r; Hardpan ElAdobe E] Fil! <br /> F_ 777777 f yes,': e____._______.._ <br /> ;(Plot plan, showing size of lot, location of systemin-relati-towells, buildings, btc. must be placed on reverse side.) ) n <br /> rNEW INSTALLATION: (No=sept c tank r esr epage"gyp permitted if public sew�r is available within 200 feet,) �* <br /> PACKAGE TREATMENT()] SEPTIC/TANK <br /> W. r <br /> i <br /> . F <br /> -- ( <br /> Liquid Depth.--------------------------- -- ---------------------------------------------- <br /> ---- Compartments i -O_Material--- -----Capacity - ---_----_ ----- <br /> .Distance to nearest:.Well-- ------------- = = = = - 'Fo nu dation-= ---- Prop. LineF- -------------------F---- <br /> 'I y } i <br /> LEACHING LINE I'1 . N f_Lines _ 9 Total Length.: ' <br /> __=_..Len.-.,,Length of each line._ __ <br /> --` ----- --_ 7 <br /> D Sox:___.._.._.T e Filter Material------ ------------Depth Filter Material-_�.___--___-___ __________________ <br /> Distance.to nearest: Well = ------------Foundation---_-------------- -----------Property Line----=------------------------- <br /> `SEE PAGE <br /> _--____:_-__ ___.____SEPAGE PIT [ ] Depth------------ - Diameter__'____. ._=._._Number__________________--------------------- ? I Rock Fined ' Yes❑ No <br /> Water Table Depth------------------ -----`--------------------------- -.-.Rock Size V--------------------------------------- <br /> :Distance <br /> -- ------- - -- <br /> Distance to nearest: Well______._:.._ _____'_ __ Foundation---------------------------Prop. Line___------------------------ <br /> RE AIR/ADDITION <br /> _______________________REPAIR/ADDITION (Prev. Sanitation Permit#-- _ � -__---'------------------------Date----------------------------- -------)� � ) <br /> r. <br /> Septic Tank {Specify Requirements) ---- ---------- ------------- <br /> = = = - <br /> Disposal Field (Specify R qui'renients)....._....._ "._._ ./ `_/ / i <br /> L 5 <br /> `'"--=----------- -i- ---- ------ ---------__-------,- -: - ------------------ ----- ---- - .- ------------- - <br /> u r <br /> ' (Brew existing and required 'addition on reverse side) <br /> I hereby certify that4 have prepared this application and that the work rwill 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:",r ° <br /> "I certify that in the performance of the'work'fol which this permit is issued, I shall not employ any person in such manner as k <br /> 9 � I <br /> SigneSi <br /> d ------------- ---- - -- ---------------------------------------f _ <br /> to become subject to War m_ an Compensation lawsof California."- Owner <br /> By-' = = Titled/W fir/./. <br /> -- --- <br /> (if ather­,than Aowner} e <br /> FOR- EPARTMENT USE ONLY41 <br /> n <br /> APPLICATION ACCEPTED BY --`----- ---- ----- --- ------ ---------------------------= --` DATE _1-----�--- --------------------------- <br /> DIVISION OF LAND NUMBER.---- '--------------------------' = = QATE. = <br /> ADDITIONAL COMMENTS -'--------------°---- <br /> ---'------'=------=------=-------------------- ------------A------ ----------------------------------------- ---------------------- -------- <br /> -----------------------=-----------=---- ---- ---------- --------------- -- ------- -- --- - -------- --- ----- - ------ ---------- --------- -------------------------------------------'--.-.- <br /> --------- -------- .-1i----------------- . <br /> -,i <br /> ---- r <br /> --- --------- <br /> ------------------ ------------------- ----------------------------------------------------- ---------- <br /> -- <br /> -Inspection,b --------- - 4 w - -��--� � __ Date_ ? :__ - <br /> y ------------------------------------------------------------ ------------- -------------------- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21677 REV. 7/76 3M <br />