Laserfiche WebLink
1 <br /> FOR OFFICE USE: / FOR OFFICE USE: <br /> (/ APPLICATION FOR SANITATION PERMIT <br /> --•------------- - ... - -- Permit No .. .. <br /> F;1I� (Complete in Triplicate) <br /> Date Issued.l0..:; 1-�� <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. i <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB AQQRESS/LOCATI .Q. 3...... .......... . •----......------..------.....---- -- .f ------� ...........CENSUS TRACCT--.------------ �7 <br /> .... --- - Phoneo.a >3. .�P_ .1...... <br /> Owner's Name.... ... ` k- <br /> ....,. .... 7 Ls-3� <br /> --------- <br /> Address...---............... . ..-r .. -- - :.-._... _ __.-. City _...�._z.iP . _ <br /> :: <br /> Contractor's Name.. ......- --- --.....License # .................. Phone3. P---.---.- f� <br /> Installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other---.--- ....__ - I / / <br /> Number of living units .....-_Number ofjbedrooms-. - -Garbage Grinder.._. lot Size...17,^ ..x...!Z- .-- ---•-------- <br /> Water Supply: Public System and name.......'- ------.Private <br /> S :Pu.- ... --------- ----- --- -- ❑ <br /> Character of'.soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ -Sandy Loom ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Material.. .... ....If yes, type------------------_....... <br /> ..-- <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 204 feet,) + <br /> PACKAGE TREATMENT ( ] fi SEPTIC TANK [ ] Side.......... _/.e�-o.0.'.?- A-- ------Liquid <br /> f Depth.. :----.- ----- <br /> Mateial..� C.t " . ...:No. Compartments.............Type" <br /> Distance to nearest: Well..�-!�-C-...-L?.G !�.. 'r""'"`"" <br /> _ ..... Foundation.. Prop. Line.._. .- <br /> LEACHING LINE [ .]f''No, of Lines •--- .- ----------._..Length of each line....... - '...- Total Le ngth .. ._-- _2 0................... ] <br /> z'D' Box....1.-....Type Filter.Material_STA'"ddcDepth Filter Material.....- ------- ------------------- ----•• ' .t <br /> ' `Distance to nearest: Well-.-----I -A--------...Fourid ation---------------------........Property Line....------------------. ------------ <br /> 3 ' <br /> j NoSEEPA E PImeter. Rock Filled YesNumber <br /> Water Table Depth---------------­----..... .................. <br /> ❑ <br /> .... ..Rock Size.:..�_.%-.a- s= .... -- I <br /> i Distance to nearest: Well------- :. _.:Foundation--- ...................Prop. Line.------ -------. f•l <br /> -- <br /> •-.. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#------------------------ •--- --------- ..........Date---.._--.-------------------------- ----------� <br /> Septic Tank (Specify Requirements)---: ----- :. <br /> Disposal Field (Specify Requirements).'................. <br /> .................................. ............------. ..-•----------. ------.... ------ -­---------------------- ....... . -- - -- --------------- --....... <br /> -------------- ----------------- ------------------- -- ---•- ---------- ---- -- ---------- <br /> [Draw existing and required addition on reverse side) <br /> I 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 Regulations of the San Joaquin Local Health District. dome owner or licensed agents <br /> signature certifies the following: <br /> "I certify that in the performance of theYwork for which this -permzit, is issued, .I,shaflF.nok ertsploy any person in such manner as <br /> to becomes 1 ct to Workm n's C pens ors laws of California." <br /> Signed-.--..... .. . <br /> -- --- --- ------ - � .-------.Owner <br /> B -------- -------- .....Title---------- -------------------------------- ------------------------------ <br /> (if <br /> ----------- ---- -(if other than owner) <br /> FO <br /> R D PARTM NT USE LY / <br /> APPLICATION ACCEPTED BY --- --- ------------------- DATE f d 3.. <br /> OF LAND NUMBER. DATE..... -----_----------- <br /> ----------- <br /> DIVISION <br /> . •...... <br /> V <br /> ADDITIONAL COMMENTS. --- - ---- <br /> ............................. <br /> ------------------------------------------------- <br /> ------ <br /> _ _ <br /> ��- � ' B <br /> Final Inspecnon by:... ... Date ---- - --_-- <br /> Eli 13 24SAN JOAQU N+ I LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br />