Laserfiche WebLink
FOR OFYCE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ......:..•-- (Complete in Triplicate) <br /> Permit . ..................... <br /> mit No S <br /> � ,.. ._ <br /> f This Permit Expires f Year from Date flat¢ Issued <br /> ed--•- <br /> S, <br /> _.... .. <br /> Application is hereby made to the San Joaquin Local Health district #oro 0 011- i4q <br /> C described. This application is made in cam lion a with Count Ord•na permit to construct and Instal! the work herein <br /> complion <br /> 00 �. Y �a{r rcI 54� ansting Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..-... 1.1 -C.alC.�-.._._. �• ca•.•-•••cENSUs TRACT <br /> . . . :... ..... <br /> I. ....-.................... <br /> Owner's Name _.-�—�.-�-f'�.12._L-�� �.-Q. _�}t1•�.f.�.AJ-..�-. <br /> !!!) ••--•�.A ...............Phone Address ....-.... '.Q.' �. _Q.`�'-----_. . <br /> Contractor's Name ---.�' .�.1 "T_�- --• ".�"�"G '1 ......License # .�1 <br /> .-- .7 Phone -4�l�.�- .' <br /> Installation will serve: Residence©Apartment Housefl Commercial❑Trailer Court„,,/` Motel ❑Other..--L <br /> Number of living units: ) _.-.Number of bedrooms '__.Garbage Grinder .- Lot Size <br /> ...A: - <br /> Water Supply.. Public System and name [ <br /> � PP Y� <br /> y +77.1r............... ..larlvate � <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam fl Clay-Loom�.,• b� <br /> Hardpan❑ �� <br /> Adobe Fill Material ..._.._..... if yea, <br /> type ............... ............ <br /> {Plot {clan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side. <br /> NEW INSTALLATION: {N��o septic tank or p ) y� <br /> seepage it.permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT ] SEPTIC TANK f'`� <br /> •...............•-• Liquid Depth .�. ` 7r <br /> Capacity el_ ---..._ Type -J9i 1ZF%.i�Mater oI.-r 6 C11S_ No. Compartments <br /> Distance.to nearest: Well ' ..Foundation ! <br /> ,4. <br /> � � ----•�Ai<,1.................... l.i??_........__ Prop. Line ....s�'P.'.........7 <br /> LEACHING LINE `( No. of lines .--_..'1 ---_- f � <br /> k Length of each ....... Total To#al Length .......1.6-50..'. 7, <br /> E 'D, Box ... Type Filter Material ” <br /> ' Depth .Filter Material :....,1 dam..._...._ <br />' Distance to nearest: Well _..' lQ..�...... Foundation _...,24V........ Property line ......4, ....... <br /> SEEPAGE PIT Depth -----=-r7-a--- Diameter --- ._� Number ..-...._.-. <br /> "^ � ...... Rock Filled Yes� No Q <br /> Writer Table Depth ....:............. <br /> ...Rock Size - <br /> Distance to nearest: Well ................ Foundation .............. prop. line <br /> REPAIR ADDITION(Prev. Sa�nitation Permit# .......... --------------- ----•- Date --_ .................. <br /> Septic Tank lSpecify Requirements) --.:......- <br /> F Disposal Field (Specify Requirements) .................................... <br /> • ---------- <br /> ----------- <br /> -- ---------- ---------•• ----------- ------------•--.................................................... ................................. <br /> t (Draw existing and required addition on reverse side) <br /> I herebycern that i have�,prepared this application and that t the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,,District. Horse owner or licen. <br /> sed agents signature certified the following: <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 <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .--..--� I� :__-- Owner <br /> BY I�. Title ....------- . <br /> llf other than owner) <br /> R D. PART ENT USE ONLY <br /> APPLICATION ACCEPTED�BY�'m -.... --_ 111 /BUILDING PERMIT ISSUE -AI!. .7_:_..- <br /> DATE..,:.5`l� ;�) <br /> -------------------------------------- ---- ----- ----------. .- . . ..--.-DATE -.....---.......... <br /> ADDITIONAL COMMENTS ---9. ................ ........... - . . ..-.....-..-.-.---••--- <br /> ' --1�i .c-._6-! -- - -----------------•---------------------------------- •--------------------- ---- <br /> -. <br /> t '. �. <br /> -- <br /> -------------- ---- �..ay_.' i •-r <br /> Final Inspection by: . �* :>s �! 7 -_............ . --------- ........... <br /> �,- ._��_, ,�..�--•----•-----•..............................._..-.-........--....-..---..Dare ti��-f�/J-....- <br /> EH 13 2I� 1-613 �v. ----•--­---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />