Laserfiche WebLink
a <br /> FOR OFFICE USE: ip FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> -- ------------------------------ -- Triplicate) Permit No..�-�---- ----- <br /> [Complete in <br /> ----- - -------------------------------------- ----- -f 8-7 q <br /> - - Date lssued_�=�-------------/ <br /> This PermiyExpires 1�Year From Date Issued <br /> •-------------------- -------------- <br /> Application <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 549 and existing Rules and Regulations: <br /> �✓- - --- -- s --CENSUS TRACT.---.--- ' <br /> JOB ADDRESS/LOC T .51 = f' _ . � �J r i r 3Lt - <br /> .'?' ------- �-5" �fCt C.- f; �' ---.-�----- -- e- -�:-------- ------------------------ <br /> ----------------------------- <br /> -------- <br /> -------- --- -------- <br /> Owner's Name.:__.__- _;: � -- �s hon <br /> ------ Zip <br /> Address---------------- ----------- - r <br /> f o °n <br /> Contractor's Name <br /> cense # Ph e EiV�_r_ ��° <br /> Installatiori'will serve: Residence �T Apartment House ❑ Conimeraal ❑F Trailer Court ❑ <br /> Motel ❑ - Other •- --- <br /> / - ----- ------ - <br /> Number <br /> .of living units:_.'_._ Number of.bedrooms -____ Garbo a Grinder ._ Lot Stze_" /__ <br /> 1 <br /> � ( - /; � '�' P to <br /> I--- <br /> WL <br /> Supply• Public System and name------- = ------ ---------- - -- :-- ------------------- <br /> Sandy <br /> :-- . = riva <br /> , f x H sof 3 feet: Sand ,Silfi CIO <br /> ea Y❑' S ndy Loam ❑ Clay Loam [� <br /> a { <br /> Character of sail to a de th o b r „r.r, ; _ <br /> dpan ❑ Adob., ill Material .._ -- If e�, type.__' ..__ ------ � <br /> (Plot plan, showing 'size of lot, locatio'of system in.relation to'wells;buildings,'et�c-.�'must be placed on reversE side.] t 1 <br /> NEW INSTALLATION: '.(No septic tah0or' seepa a pit permitted.�if public sewer�is available wi#hin 200 feet,) �/ <br /> SEPTIC TANK[ r , 1` �/ - ;jam ''' iquid Depth`t_1/2 <br /> PACKAGE TREATMENT [ ] i Ze 1/ /" �'' "- I , -��� z� <br /> a o <br /> Capacity-)�° ---`TyPe <br /> Q�Material_ ;vNo. o 6 6rtments__ <br /> ')d J ` <br /> Dis#' ce..tanearest::WelI -- -=k.:Ow`_ - ---_-'_ti-Foundation� / -------------- Prop. Line._ <br /> i <br /> - �' r --"--T,otal Len ,U <br /> LEACHING flNE No.'of Lines <br /> s -� Length o each line._ <br /> } Length <br /> .____/.;7,6 <br /> Filter Material U h Filter Material-______ '�-f'--------------- <br /> D' Box---- -- A <br /> De t- <br /> r, Dis`. . .. i .. , ...........I..1/ . �_. i <br /> �' - ------ - ine <br /> to to nearest Well -w--.-"-" _-Foundation__ aoperty <br /> Pr L' <br /> J ,. C <br /> SEEPAGE PIT [ De th__ �T ___Diameter_ � -------Number-._'__" Rock Filled Yes, <br /> P - <br /> Water Table'De 'th_ ---_ J I <br /> Rock Size %`Z / ------- ddd <br /> Dis#an to neares"t: Well.. �v.0 --�-� Fou_ I ------------ -- <br /> P <br /> - - rtiifation._4 _�____.__.Prop; Line__ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#_-.-_: --- date--_.____.__- -------------------- <br /> ----- 1 <br /> :.�_ <br /> -- <br /> Septic Tank (Specify Requirements)-------------- - -----=--=--- -------------- -- -- --------- -------- <br /> ----------- <br /> ----- ------- - -----:- ----- ---_---- ----------- <br /> ' -- <br /> Disposal Field (Specify_Requirements) --.---- ---:-...___---- - _= r 5 <br /> ( ----------------- <br /> ---------------------- <br /> ----------- - ---- ---- -- <br /> r <br /> ! s r --- <br /> - 1 <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, Horne 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, 1 shall riot employ any person in such manner as <br /> to become. subject to.Workman's. Com ensation„laws of .California."_ <br /> Signed-: - :- _. <br /> ned_:_ <br /> } k i. _.. : - ------------- <br /> Titlei <br /> �_ n <br /> By <br /> : <br /> (I#"ot 'er' flan owner] <br /> i . <br /> ' FO EPART . ENT USE ONLY � <br /> ACCEPTED BY--- == --- ----- ---------------- <br /> ATE <br /> --------- - DATE. <br /> I <br /> --------------- <br /> APPLICATION <br /> R - ATE---- - ------- ---- ---------:.--:, :------- <br /> DIVISION <br /> ----=------------ ------------------ ------- ------- ---- <br /> ADDITIOf AL COMMENTS. _ -- -------------------`--------------------- � = <br /> ---------------------- ----------------------------- <br /> ------ ---- - -------------------------------- - <br /> ---= AINLOCA <br /> = ---- -- -- - --- --- ---- -------------------- -= --------------------------------- 1 <br /> Final Inspection _ "------ --Date - - = <br /> i <br /> A \ -"-�� F&S 21677 REV,7176 3 <br /> EH 13 24 SAN J A A DISTRICT <br />