Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USE: ` <br /> #: APPLICATION FOR SANITATION PERMIT <br /> Permit No......7f- 6 <br /> -- (Complete in Triplicate) <br /> -------------- ------------------------------ <br /> n <br /> ------------- -------- <br /> -------------------------------- � Date Issued__ <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for`permit to construct and install the work herein described. <br /> r <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: .Y r <br /> ` CENSUS TRACT.. -- <br /> JOB ADDRESS/LOCA ON _.._-- ------------------,-�" -- - , <br /> Owner's Name..___ <br /> � i[1 � ------------------ - ------ --- - - -------- -. Ph --------------------- <br /> ,.a* <br /> A = # -Ci /jC d��i ,<---------------- ------ <br /> Address.---- - ---------------- <br /> City- / <br /> i nse Phone-- <br /> Contractor's Name--c _ -- e -� i ------ - -----------!-Lice. . <br /> Installation',wilf serve: Residence ❑ Apartment Hous 'Commercial [-11Trailer Court El <br /> Motel F-1- - Other-- <br /> 4 <br /> Number of living units:----------------Number of-.bedrooms_.__,Z,_"Garbage Grinder.- ---.'.Lot Size----- -Q / S:l� '.S-._--_.- ---- .--- <br /> r F #} ° ------Private R9 <br /> Water Supply: Public,System and name ---------.-,_---:-----= - -. ------------------- ----------------- ------------ -- -- <br /> Character of soil to a depth of 3 feet: Sand ❑ :Silt El Clay ❑Peat El Sandy Loam Clay Loam ❑ <br /> t .. . <br /> Hardpan ❑ Adobe ❑ Fill Material--.-[----`,_kf Yes, type-----------------=-------------- = <br /> (Plot plan, showing size of lot, location of system in re'lat'ion•to wells, buildings,.etc. must be placed on reverse side.) <br /> NEW INSTALLATION:•" .;(No septic tank or seeplage pit permitted if public sewer is available within 200 feet,) /y t <br /> PACKAGE TREATMENT['] SEPTIC TANK [�''�" )`T� ize---- _ L=:. :- ' ---- -Liquid Dep#h=---c' ----------------- <br /> �a ©0 T e Material- ` '-No. Compartments.- -�---- ---- -----------t•-- U <br /> Capacity= ;-- "` YP. <br /> ! jj 02 ,. .-Prop. Line---3- I. <br /> Distance to nearest: Well_____________ ____ _ __ __ _��.-a.,:.,.e+-_Fo,undat ,. f�; p <br /> Length of each line..-- - .-- - ' -T th7' L ---- <br /> LEACHING LINE (<.No. of.Lines---=---f_. -- - ' g --:---- ---. y-. <br /> -Total- Leng - ------------- -- <br /> 4 <br /> s f �y����De Depth Filter Material-.. ' <br /> ;D' Box- --- '--Ty-pe Filter Material ---------- p sp t <br /> t F 1 + ---- a Line ------ ------ <br /> Distance.to nearest: Well...t L�-._... ' .. Foundation _ _Proper Rack Filled Yes <br /> 4 <br /> SEEPAGE PIT [ Depth �..Qiame-ter- - _ --Number-_ ` �� ---- -- /` L NO <br /> oc }}Size �.J <br /> Water Table.Depth_ ..... !- - r ._ A� f" <br /> II r_ ._. Foundati'on�- __::�----- -_Prop. Line -_ <br /> Distance;to nearest: Well. -(-. - __- ---------- <br /> ------- <br /> _ . - <br /> l� ` G[ . # <br /> REPAIR/ADDITION (Prey:•Sanitation Permit#_-:- - - `�-- --------=----------•------ 1 ; <br /> , <br /> 1 _ � <br /> Septic Tank (Specify;Requirements)--- =' = -- ---------------------------------- <br /> Disposal <br /> 4 -- <br /> Field (Specify Requirements)----------------- --- -----------=------ - -- <br />] I <br /> -- ------------ - =---- - <br /> = i� - <br /> -" - ---.._ ., <br /> ----- '----- ....._------- ---'- ------ _ -------...t- ---- ------; ----- --- - - ---- <br /> _. .. :� <br /> (Draw existing and required addition;on reverse s+de) � <br /> I hereby certify that-I have prepared this.applica onfand thaijhe work will be done in accordance with San Joaquin County <br /> Ordinances,' State Laws- and Rules .and Regulations of tale San Joaquin Local Health District. Home owner or licensed. agents <br /> signature certifies the following: E _ <br /> f [ <br /> "I certify that in the performance ciV fhe work for which-this permit is issued, t"shall not employ`any person'in such manner kas <br /> to become subject to Workman's Compensation; laws of.,.Colifornia."- <br /> k �� . <br /> Signed------------ -Oweer <br /> + �.. ' <br /> BY ---------- ----- -- - --- ------- -- - <br /> (If other than owner) I <br /> t. + FOR DEPARTMENT USE ONLY '' t <br /> fQATE � �f.. <br /> APPLICATION ACCEPTED. BY r ms ---------- <br /> a <br /> DIVISION OF LAND NUMBER:" ----------=--------------- . <br /> I ADDITIONAL COMMENTS-----= ------------------ ----------- -------------------------­:- ----;----------------------- <br /> ------------'-------------------------- ----- ------------- <br /> ----------- --------------------------------- ----------- <br /> -- <br /> -. . . : ------------ <br /> Final Inspection b z -----------Date-- .--�.----- -W-.r <br /> k EH 13 24 a/ SAN JOAQ IN LOCAL HEALTH DISTRICT F&s 21677 REV. 7/76 3M <br />