Laserfiche WebLink
VFOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------ --------------------- Permit No.�y:.- <br /> (Complete in Triplicate) <br /> --------------------------- ---- ---- ---- --------- ---- Date Issued_1P_-A9:15� <br /> ---------------------_--------------------- ------_----- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Heolth District for a permit to construct and install the work herein described. <br /> This application is made in complia�n+ce with County Ordinances No. <br /> 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION. J- -".--�-- " CG'_, CENSUS TRACT <br /> ---------- --------------------- <br /> -- <br /> - - ------- <br /> Owner's Name-------- '------- <br /> Phone <br /> - -------------------------- - ----------- -- -- ---- <br /> Address.------x--------- x- <br /> - ------------------ -- -- <br /> Contractor's Name----- _ _r �!----- dC-C <br /> ----License #----------------------------Phone------------.---------- <br /> Installation will serve: Residence E] Apartment House ❑ ,Commercial 71 Trailer Court ❑ <br /> Motel ❑� Other__ a.l fL_._e <br /> Number of living units:_-_ ----------Numbs of bedrooms-:;;::�----Garbage Grinder------------Lot Size------ - ._..___.____.___,_________________ <br /> Water Supply: Public System and name--------------------------------------- --- ------------------------------------------------------------- --------------------Private 0 <br /> Character of sail to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ k4Hardpan ❑ Adobe ❑ Fill Material___---------If yes, type_______________t __ <br /> ILI <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,] <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size_. _ _ _. ___ . _r____.__ Liquid Depth_ �Z� ------- <br /> Capacity/_CI�11"---- ---TYP CC <br /> -------Material---------- --------- -----No. Compartments----�----------------- -- <br /> Distance to nearest: Well__.fj_Q_------------------------ ---_Foundation..L__Le--------------._.Prop. Line.:_'.__________________. <br /> LEACHING LINE [ ]._._No,"of,Lines---(`t-------------------Length of each line'-._«--------------------Total Length ---- ----------------------- <br /> i r <br /> i 'D' Box._ -__Type Filter Materially i.7epth Filter Material____ __ �--____"_--""_"""___.____ <br /> "'�� - <br /> {--rtDistanc0 to nearest: Well--5-0. """.Foundation__ 40""�___".___Property Line.___'SJ____--------- <br /> SEEPAGE PIT . [ ] Depth-------------~'Diameter---------------------Number------------------- ------------ Rock Filled I Yes ❑ No❑ <br /> - L . :, <br /> Water Table Depth= r:' Size------ ------------------------------------------------------- <br /> Distance;to nearest: Well-_+_'__:.-.--------------------------------Foundation---------.----------------Prop. Line-'--_-----__--------------_. <br /> REPAIR/ADDITION 12rev. Sanitation Perrin-t#--------�J------------------------------------- Date----------------------------------------------1 <br /> i E + <br /> Sep is-Tank (Specify Requirements)---------- `----------'-- ---'---------------------------------- - ------------------ -------------------------------------"-------------- --------- <br /> . <br /> Disposal Field (Specify Requirements)------ ' i_ 4 - ---------------- ------ <br /> ------ <br /> ----------- ---- ----—----------_ <br /> " ' (Draw existin@, nd required addition on reverse side) <br /> 1 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 IRegulatio};: of the San Joaquin Local Health District, home owner or licensed agents <br /> signature certifies the following: ik' <br /> tI"I certify that in the performance of the t for which this permit is issued, I shall not employ any person in such manner as <br /> to become subject, rk�a Comps ation laws of California." <br /> .k �------------------Owner <br /> 5igned'a� x ---i_­__�------------------ <br /> ----------- ---.- s ------Title-=------------------- -------------------------" <br /> = - <br /> (If other;than ownerj� <br /> F R-DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- - DATE. --- ------7c:5 --•- -------- <br /> DIVISION OF LAND NUMBER-------- .DATE-------------------------------- - ---------------------------------------- <br /> ADDITIONAL COMMENTS-----------------------------------'--'---"--"___-- <br /> --------------------------------------------------------------------------------------------- ------------------------- ----- ------- ---------------------------------------------------------------------- <br /> ----------------------------------------------------------- ----------------------------------------------------------------------------------------I----------------------------- -------------- ---------------- <br /> - ----------------------------------------------- -A---------- ----------------------------------- <br /> Final Inspection b r Date..____. _ �_ <br /> -- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV. 7/76 3M <br />