Laserfiche WebLink
..N r <br /> FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ` <br /> x Permit No. ..7y=--••• •- <br /> ...... ......---------I ..__.._...._.._....... (Complete in Triplicate) <br /> --••-•.............................. t Date Issued ---...�._.:..... <br /> This Permit Expires 1 Year From Date issued <br /> Application is hereby made to the San Joaquin tocol Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No/5'49 and existing Rules and Regulations: <br /> r CENSUS TRACT .......................... <br /> JOB ADDRESS/LOCATION ,......I ��._,. -VC . / .-:i�_..._y............. .... <br /> . �6•- ...................Phone <br /> Owner's Name �' -..... <br /> Address ..----------------------------- ........................... <br /> .......... City = ?5.N.100..........................................'. ....... <br /> Contractor's Name ......... ..r__.. <br /> � - ..._.... ;License #-��3-� ..... Phone ... ..... .6 s <br /> Installation will serve: Residence 0 Apartment House❑ Commercial ❑Trailer Court .❑ <br /> Motel ❑Other .................. I <br /> Number of living units ....... Number of bedrooms .._ ..._.__.Garbage�Grinder ............ Lot Size .....-.�°�'•�-�---•••••-•----• -•. <br /> r Private, <br /> Water Supply: Public System and name .... --------------------- -- - -- ..... <br /> Character of soil to a depth of 3 feet: Sand.% . Slit❑ Clay ❑ Peat+❑)Sandy foam 1] Clay Loam [3 <br /> Hardpan ❑ Adobe ❑ Fill Moterialro-'----_-_ If yes,.type ---------------------------- <br /> (Piot plan, showing size of: lot; location of system in relation to wells, buildings, etc. must be placed on reverse side.] <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if ub)ic 5`7 is SQylabw�t}}ar 200 feet,) <br /> - ... <br /> -... �.. ._..--,.SLigq/uid Depth .���._.�..------ <br /> PACKAGE TREATMENT [.] SEPTIC TANK .. <br /> Capacity Type Material...`... No. Compartments OK.................. <br /> '" <br /> Distance to nearest. Well � '�ouJdation ...../�............ Prop. Line .. .................. <br /> -��-.e'-_-_----- <br /> i} <br /> LEACHING LINE ] No. of Lines .._.._.a- _Length_ of, each line.l '��.; �... Total Length o.....-••...•••• i <br /> f 0 <br /> 'D' Box ....�._.._ Type ilter Material.- t f .:--Depth Filter Material .lS� ..._._•--•.----•---••-•----- <br /> C 1 ! P <br /> Distance to nearest: ell ...S�'_...__...... Foundation ...✓rG2_ ._..__.... Property Line ........................ 0 <br /> SEEPAGE PIT fDepth _.. `-�' ��Diametec .`........... ... NumbeL.r..----...�------..... Rock Filled Yes ❑ No ❑ <br /> 14 1% <br /> Water�7able Dept 5, ..... . ......Rock Sized m <br /> - <br /> Distance to nearest Wei: t '' ' g `Foundation `-~. Prop. Line .... ..-. <br /> 9 <br /> REPAIR/ADDITION -rev. Sanitation.Permit# Date ---...............................) <br /> Septic Tarek (Sp �ifyequirements) .: -----------------... ..... 1!1d --•-•---------•,•-••-------•----••---------•-;,........:._------------_..-------- 0 � <br /> y� <br /> Disposal >~~i'eld {Specify Requirements ------------------••----- --•..............------------.----------......-------...,,......................................-•-------.�_- - <br /> i <br /> ...........-----•----...-•---•-----•---••-----•----••---• =l­--------------...........�-----------------•• ,-•--- y <br /> (Draw existing and required addition on reverse side) <br /> 1 herebycern that I have prepared this application and that the work will be done in accordance with San Joaquin"�'� <br /> County Ordinances�, State Laws, and Rules and Regulations of the Son.Joaguin Local Health District. Home owr�r licen- <br /> sed age s signatu� certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any parson in such_ ner <br /> as to bekome subject to Workman Compensation laws of California."" <br /> • 1 Owner <br /> BY <br /> Signed ----- ------------ <br /> '" _ Title _ .. .. <br /> If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .............:�............ _.. ---=• ............................. DATE ....�_-_/�.--.�..... <br /> BUILDING PERMIT ISSUED _....._.. ------•---•-----•........... ......DATI` <br /> -- <br /> .. <br /> ADDITIONAL COMMENTS .6:7-40,c � ......__ J 4 <br /> A <br /> ---------------�.._�­ . ...:....-.. <br /> ............ ......... ..........._.._......---•- - <br /> -----•---- ---------------------- ------..........-••••--------- <br /> ...Date <br /> Final inspection by; •.•.•••�• , <br /> SAf50AQUIN AOCAL HEALTH DISTRICT *62 <br /> :'�' € - �,.-•t�� 7172 3 M <br />