Laserfiche WebLink
f <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> !Y_ _ APPLICATION FOR SANITATION PERMIT �7 7 <br /> T - Permit No._2;=" -6V/ <br /> i <br /> {Complete in Triplicate) <br /> ' ------------------------------- --------------------- Date Issued 2.`,�`.7=_J <br /> --------- This Permit Expires 1 Year From Date Issued <br /> A lication is hereby made to the San Joaquin Local Health District.for a permit to construct a�d instal. 'the �work herein described. <br /> pp� <br /> This'application is made in compliance with County Ordinance No. 549 and existing Rules and l2egulafions`: <br /> JOB ADDRESS/LOCATION. /- - - J <br /> CENSUS RACT___" <br /> Owner's Name.. -- ---- . ---•••------------------- --- ----- -- ,----- : :----. <br /> - � _ ----=�-- -- ---•- one <br /> g Address"... . e � <br /> --- -- -_ _. ,�fY,/.. -�: - --- ZIP <br /> . . , Phone <br /> License # <br /> Contractors Name__-- -- -;-_---:- <br /> -- V71--- l""" /7 <br /> ------------- -- <br /> " '. . <br /> Installation will serve: ;. Residence. Apartment House.❑ Commercial ❑ Trailer Court ❑ <br /> Motel-Q--_- Gther ------' ' � /' <br /> :: - i. _<._.. <br /> op ----- --L <br /> Number of.living units:__'_ --______Number of bedrooms:_ _ _ Garbage Grinder-- -.___.Lot.Size.__-__-_� - -G -L� <br /> F r <br /> i r -------------------Private <br /> Water Supply: public System and Warne - .- .r <br /> Character of soul to a depth of 3 feet: ~Sand [I �i:Silt E Clay E] Peat 0 Sandy Loam El Clay Loam � i <br /> l i Hardpan ❑ Adobe:❑ Fill Material-----------tlf yes, type-------------------- <br /> I <br /> (Plat plan, showing size of lot, location of system in relation to wells, t?uiidings, 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 /> " <br /> . '---:-Liquid Depth.�--r ------------- Y <br /> PACKAGE TREATMENT' [ 1 SEPTIC TANK �'I Size_-} _- /P------=-------------- . <br /> Q �j4T e ial---'- ------No. Compartments ---- <br /> r Capacity/t`/rf.�(/ YPx = -- -- G� <br /> z t. Foundation-,4P -Prop. Line-- 11''------ ----- <br /> Distance <br /> .to nearest: Wela _- <br /> I. <br /> f, w <br /> &-EACHING LINE [�]. <br /> : 'No. ofLines.' _.__ en-enof each.1.ina------ - -----------------Total .Length, 1.:/_--- ---- <br /> T : . R e th Filter Material---------- ,--------`---. <br /> ..... . �• � tergal_- -----;� l -- - ------ ----------- - <br /> i _ ✓` ,. <br /> t, i tante to nearest. W 'II_----- <br /> D' Box- '__.. _ ..T a Filter Ma <br /> ' . : <br /> -Distance Y oundation----------------'--- operty Line =: <br /> :- R k Filled Yes+ No ❑ <br /> ,SEEPAGE PITC Depfh_�'. _,�-- Diamet r_ •�,.__.--___ Number- .-'-----..�c--'::--1ze_ • .�/ f <br /> Water Table De th- F- Rock S' f -------------------------- <br /> p <br /> t - -------- <br /> Distance-Jo nearest: We11N_r_ ---- -------Foundation # Prop. Line._-__-"_______----- <br /> . <br /> REPAIR/ADDITION (Prev. Sanitation Permit#----� �-- --`------=-----r= Date ----'-------------=-- '------------- --- ) <br /> r ; � = ---- ------------ -- ---------------------- ---------- -------- <br /> " --------- <br /> t Septic Tank (Spe_cify Req,uirements)--------------------------------------=---- -- <br /> rr -------------- ------------ ------------------------------ ---- <br /> Disposal Field (SpecgfyrRequirements)--- ------- <br /> ----------- <br /> ! sI ------ --------------- :.„ :. ------------------------------- <br /> ------------------- a <br /> -----:-- ------------------ ---- <br /> ------------------------- <br /> .. � __ addition on reverse side = <br /> - ,,,` . - .;existing and e <br /> 1 "" " certif that=lahave re ared thFi�srappllahon and th aired ad ) <br /> I hereby A y � p p at the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of; t�Fie San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: 0 g <br /> "I certify that in the performance of`the`work 1for which this permit is issued, I shall not employ any person in suck manner as <br /> to become subject_io),Workman's. Compensafioa laws oft Caaifornia:E.'. + i <br /> 1 k�o <br /> wned <br /> Signed- ----- - ---------- --- ----- ----------- <br /> --- - Title_Y-` ,er than. owner} <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__- ------------------------------------- <br /> ----------- <br /> E.:----� Z� �-�------ <br /> -- <br /> DIVISION OF LAND NUMBER------:------- -- ----•---DATE--------------------------------- <br /> '- <br /> ------------------------------- <br /> ADDITIONAL COMMENTS <br /> ------------------------------------------------ <br /> � �. --- <br /> --------------0/5:;7 ` ---------- - <br /> - €� <br /> = ---- --- ti -t <br /> -------------- -- ------ ------------- --------------------- <br /> -1-'Date-- <br /> --------------------------------------- <br /> FinaEns ection�bY -- -- ---- --------- ------ -------------------- <br /> k <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F85 25677 REV�7( 3M <br />