Laserfiche WebLink
FOR OFFICE USE: Y <br /> .......I--------------- ------- --- APPLICATION FOR SANITATION PERMIT R OFFICE USE- <br /> (Complete <br /> SE-(Complete in Triplicate) Permit No. � <br /> i <br /> -­-­-------••--- This Permit Expiresl Year From 8ate,lssued Date lssued� f�7.� <br /> 5`gsQ_ �v. �.w a�f �q... <br /> Application is hereby made ta.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 /> JOB ADDRESS/LOCATION_�¢ [�— "" ... u <br /> ,, v__7`j..CENSUS TRACT.. <br /> ' <br /> I Owner's Name...... <br /> . - <br /> Address. �� --- - ------- <br /> .-- Phone . . ... . �QL .- ......... <br /> -. .. •- <br /> _. <br /> Contractor's Name_.._... <br /> ..` � — i�' -------------------Zip- <br /> - <br /> -...License #-. .Q l`��....."....Phone._ / . <br /> Installation will serve: Residence Apartment-House ❑ Commercials' Trailer Court ❑ <br /> Motel ❑' Other_......... <br /> . <br /> Number of living units: of bedrooms..... "Garbage Grinder_..,.....--" <br /> Lot Size. .._" <br /> I � � <br /> u <br /> Water Supply: Pblic S stem and name_.. ......... -- <br /> � y ... <br /> Character of soil to a depth of 3 feet: Sand Silt -Cla -- ------------------ Private <br /> ❑ ❑ Y ❑ Peat[] Sandy Loam ❑ Clay Loam ❑ <br /> ' Hardpan ❑ Adobe . Fill Material.....-. "...If yes, type........... ................... , <br /> (Plot plan, showing size of lot, location of system in relption 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---..----- <br /> ......".... <br /> --------------------------------- --------- ----Liquid Depth.--=--------------- <br /> - E <br /> rCapacity....._.- Type -....Material--------_...............:No. Compartments.----- - ( ] <br /> r - Distance to nearest: Well.:... = Foundation... * Prop. Line �1 <br /> LEACHING LINE L <br /> [ ] No. of Lines.. on <br /> ---.Length of each line,...-----.----...- <br /> +' <br /> .T..,.., . }. �.. 9 'a <br /> D' Box---...__ ...Type Filter Material._-......... _Depth Filter Material oto _Len th _"...:_=•:-----. -.._---_. ... <br /> Distance. 4 ' arest:Wel1S.._...:.....""..: i Z <br /> .....---.Foundation-------- -------------------Property Line..... --- <br /> SEEPAGE PIT f ] �Depth..- - __-Diameter----------- --_Number.---------.-""""--- <br /> �` I ------ Rock Filled Yes ❑ No <br /> . Water Table Depth...................: <br /> ......Rock Size-- ...... <br /> ..p •------------ <br /> Distance to nearest: Well"-------------------- -----Foundation--- .... . Prop. Line.-- ------- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#..-. <br /> ----------------------- ......... <br /> •.,. <br /> Da .. 1 <br /> Septic Tank (Specify Requirements)....�.�,�" . <br /> Disposal field (5pe 'fy R quire :y. ,!/ � , <br /> •- <br /> ------------ <br /> ------------------ --------.--------------------- ----------- <br /> _ (Draw existing and required addition on reverse side) <br /> I hereby certify that I have-p-re' this application and that the work"will,.be done in accordance with San Joa uin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin"f:ocaI-Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> I <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> tobecome subjec o orkman's Co ensation laws of California." <br /> Signed........._.."..... <br /> ..Owner <br /> $Y........... . . Title <br /> (If other than owner) <br /> y <br /> OR DE RT NVUSE ONLY <br /> APPLICATION ACCEPTED BY_.--... yt t <br /> ----------------------TDAnT ..... <br /> DIVISION OF LAND NUMBER....---- ------ .... ..... .... <br /> - - ---------- ------------ ----- --..----•- ..---------.._DATh_` .... - - <br /> ADDITIONAL COMMENTS-- -- <br /> " ..: ; , .,_ .... --- ----------- -------- - ----------- <br /> - . . . -- ------------------------------------------ <br /> Final•Inspecflon by:. - ��----... ---�..--- ---.-"---:�-_-•�-N_,:---- ---�- - -�-- -----`._....�--------•--•--'-•------•-------.'......f-----f--..----------------------------------- <br /> ----- ---- - ------- -- <br /> -------- - -------- ------------ -------- --------- Date--_ b_`"bJ�._1. <br /> 13 2a SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br />