Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
L <br /> FFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ._ g� -�--- <br /> ------------------ i <br /> --------------------------------------------------- <br /> , (Complete in Triplicate) <br /> -------------- <br /> l-- d_f C`-=I .'�g <br /> "-_" <br /> This_Permit Expires,} Year..From.Date-Issued - <br /> Application i's-hereby made to'-ttie San'aoaquin Local Health District for a permit to construct and install-the work_h_erein described <br /> This appl'ic`ation is, made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> € <br /> � <br /> ENSUS TRACT <br /> - -- <br /> - - - -- ---------C <br /> Cfl <br /> JOB ADDRESS/lOCATlON. /��/O' ------------ -- <br /> :------ <br /> -- <br /> Owner's Name---------- <br /> ` 1 --------------- <br /> • �, - - - <br /> } <br /> � � -_{_" <br /> City.� Z+ <br /> Address ---------- -- [ hon <br /> .,License h - ----- <br /> 4. , pJ <br /> - - ._, 6 <br /> ."��� <br /> P e - la L(oa + � <br /> Contrgctor�s Name=------ -_"-.F . - , <br /> '�'§` ' ar.menfi House.��Commercial ❑ ,Trailer Court ❑ <br /> Installation,will serve: Residence Ap ,,,� ❑ e <br /> .. .._ .. <br /> �,,,�,,.,,._�. �•"�` 'a; .. � - ~Mo#el-[] Other_ ::------------- -: ..... <br /> i -- -- --- .. <br /> i <br /> ( a f _1- __Garbage Grinder_ . Lot",Size_ - � <br /> � i <br /> Number of living.units: ri. �- _Number.of.bedrooms, s Private <br /> # # f ------------- <br /> namei <br /> Water Supply:,Public System�,;an�d -------------------------= <br /> Character of so to a depth of 3i feet: ` Sand ❑ Silt P`�. Clay r Peaty Sandy Loam �; .Clay Loam <br /> riii +. _. -,..-_ - . <br /> Hard an ❑ (Adobe.❑ F+II MafieriaL_.. _lf yes,type___ _ -, ; <br /> [Plot plan, showing size of lot, �cation�of systeA__in'•relation to.wells, buildings, etc.'must be placed on reuer side.) <br /> NEW�INSTA Y .i ! d e'rmitted if puti_lic sewer is available within 200 feet,} <br /> LLATION .(No.tskptjc tank or s epa eb p C� <br /> A !---Liquid Depth- - ------------------ <br /> Size , <br /> TREATMENT [`] .�SEP_TIC TANK t.l y -'.-- - - -------- <br /> PACKAGE # -. <br /> i t - --- Material ------------- No. Compartments. <br /> ii. <br /> ; .�� �` .. Capa ity�-•--:�--��"'TYPe -- -- -- -- --- --- --- --�- -- <br /> - <br /> r � r <br /> _ Distan�a to nearest:Well F undatio Pop. Line_ <br /> �a <br /> #h of each line- - dotal Length1 I <br /> LEA'CHlNG LINE [ j No. of Lmes__ 9 <br /> j - Te Filter Material <br /> = -- Filter Material___ --n <br /> "D-Box YP <br /> . _.. <br /> � _ <br /> -'r_ Foundation __ Property <br /> P Distaceto nearest: Well... ... .... ...�- , <br /> Pr rty Line ----. �- � <br /> 9 ` - -�_> �....._ _E t_ f. -_ -..4 ' . Rock Filled�"Y No <br />! SEEPAGE PIT ] Depth _:.. ". Diter,T Number r <br /> -� ....r.� <br /> Water Tableepth't Rock Sizes_ " <br /> Foana + <br /> on ------ <br /> dF <br /> ' 0 <br /> p. Line <br /> Distane to nearest <br /> 7'-'REPAIR/ADDITION-(-Prev7r-Sani�ation-Permit-# .� -- - ate--- --� 1 i <br /> - z- -•---- <br /> F&eptnk (Specy Requirements4 :• 46 <br /> 1 <br /> - 'Dim - - --------- --Field (Specify Requirements]____-=-�---- - - �------ ------- ----------- <br /> --- - • _ <br /> ------- -- - --- <br /> nr -- -- -- --.. : . ; <br /> 6 �. <br /> F <br /> i <br /> ! � (Draw existing and required addt'ion=on reverse side) <br /> r I hereby certify that I have prepared this.application and that.the.work-will be-done in ciccordance with San Joaquin County <br /> Ordinances, State Laws, aril Rules:and Regulations of,the Sari Joaquin Local Health-District. Home owner or licensed agents <br /> signature certifies the following: : F <br /> 4 ( a of the work"for which this permit is;issued, l shall'not employ any person in such manner as <br /> l certify that in the pertormcinc. <br /> to become subject.-to-Work� an's-Compensatiot+-laws-of;California.' <br /> t <br /> I -- - <br /> Ow n e•r�j <br /> Signed- <br /> � . <br /> - <br /> Title. - <br /> I (If other than owner) <br /> R DEP TME U ONLY. - <br /> ---- - <br /> DATE. <br /> + APPLICATION ACCEPTED BYE__: --- --------- <br /> k ------------_ _ <br /> DIVISION OF LAND NUMBS -- --: --------- - - ---------------- <br /> DAT ---- -------- <br /> --- <br /> - --- <br /> ADDITIONAL COMMENTS_.�G _ ------------ -- - ----------- ---------- <br /> - ------ ---- <br /> 11. 1 <br /> = --- --- <br /> R <br /> ---- ------- ----- --- -- <br /> i D t rj <br /> --- ---- Com" <br /> Final-Ins ection b --- --- . <br /> p Y •- F&5 21677 REV. 7/7h 3M <br /> EN 13 24 SAN JCiAQUIN`LOCAL HEALTH DISTRICT - ��/•���` <br />