Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------------------------------------- <br /> (Complete in Triplicate) Permit No._,7g---- .9-J <br /> Date Issued--- _�1 .: <br /> ----------------------------------------------------- ___ This Permit Expires 1 Year From Date Issued <br /> Application is hereby madejW, 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 /> A <br /> JOB_ AD...,D L 0G;, ON <br /> --- <br /> 0- _.» e�----------------.,e ----- <br /> C --- <br /> ... ..m .CENSUS TRACT ---�------------ <br /> a ( <br /> D <br /> i ----- - --Phone.-- � <br /> Owner's Name- � Q-�'�.-------- <br /> il - <br /> Address-----'-----' --- --- ----- Ci#y-- 1----- --------- --Zip.............. -------------- <br /> Contractor's Name----- - -- ' License # ..=3 - Phone 7P' <br /> L� '- <br /> Insltallation will serve: Residence A❑ rt oue E] ��rn I � Trailer Court <br /> MotelOther <br /> � .,ems � � <br /> s <br /> Number.of living. units:___._._____Number.of.bedrooms__._�____Garbage Grinder._______._-Lot Size__._Cr_______________________________ --. _ <br /> Water Supply: Public System and name _ :: ------ .--- --------- ----- PrivateX <br /> erecter of soil to a depth of 3 feet: ; Sand [] iSilt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam <br /> Hcirdpon❑ " Adobe L Fill Material___-_;__----!f yes, type----------------- ------ <br /> [Plot plan, showing size of lot, location of system i.n relation to;wel s,_buildings,-etc. must be placed on reverse side.] <br /> NEW INSTALLATION: '(No"septic tank-or seepage pit permitted if'pubk sewer is available within 200 feet,) e <br /> PACKAGE TREATMENT "[ ] SEPTIC TANK" ['"] '" Size_ ____ � r ---`----.---------------------_ e tl�._ '____ <br /> Liquid D --- -- - <br /> i Capacity- .. TYpe-------------------- -M aL' j-------- _:No. Compartments-------- - <br /> Distance to nearest: Well----------------------°-- . Foundation- --- ------ ------.Prop. Line _------------- -_. <br /> t <br /> LEACHING LINE [ .] No, of.Lines........................ _ Length of each bins-----------11 ----_I------------- Total Length ------------------t es <br /> - -------------- <br /> ---- <br /> _.__! <br /> _ ---Type Filter Material ____---_ -_---D' BoxDepth <br /> Riter Material___'---------------- -- <br /> --------------------------------- <br /> .Distanc�tonearest: Well--------------- '--„4F.oundation--,------------------____--Property Cine -- ------ .-- <br /> SEEPAGE PIT [ ] Depth------ _._______D.iameter_ _____ -----------Number---St------ <br /> _------ <br /> .___':__ ._. j Rock Filled Yes ❑ No ❑5 <br /> �; 4 <br /> Water Table`Depth '--- ` s Rock ize7 -- ; ------- <br /> to ------- <br /> a ,�- �� Distance do nearest:Well-�'----.'.-----___---'.__ "_` `� i <br /> g ----- Foundation - ---- -- Prop. Line <br /> a . <br /> REPAIR/ADDITION {Prev. Sanitation Permit#_.:..__-'------------=----------------------------Date:_---- ) <br /> Septic Tank {Specify.RequirementsM------------------- :- = ----------- -----_------ _-----__--------- _----- --------- <br /> . -7 �-- <br /> Disposal Field [Specify Requirements]------------- - � = --- - I <br /> € trAr <br /> I <br /> f - - -- -- --- - -- -- ----------- <br /> } a <br /> ----------------------------------------------- --------------------- -------------- ------ <br /> ------- -- -- ------------------------------ - <br /> i } f [Draw�exis�ting and requirpdadditionko reverse sidel € <br /> 1 hereby-certify that-1164- prepared this application and that tie work w IF-be done in accordance with San JoaquinlCounty <br /> Ordinances,. State Laws, and kulesl cn� plication <br /> of the.`. San Joaquin Local Health District, Home owner or licensed'agents <br /> signature certifies the folio <br /> winag: <br /> m <br /> "I certify that in the perfornce of the work f which this permit is issued, I shall not employ any person in such manner as <br /> to become subject to Workman's Compensation I laws.of California.'.' - i ... <br /> Signed-- = = [ =---- --Owner <br /> B = ` -----------------------------Title---- -------------------=-- <br /> (If er thantowner) a <br /> 4 <br /> Wit, <br /> D PARTM T PSE CANLY <br /> t <br /> APPLICATION ACCEPTED BY---------- ` ___________ -_ <br /> - - -- -----=- - - - - ---- . _DATE - 2 - ---- <br /> DIVISION OF LAND NUMBER--------------=-------------=---------- ----------- ----------------------------------:----------------------DATE------------------------- ---:---------- ----,--- <br /> ADDITIONAL COMMENTS-..-- ----- _ _ <br /> = � �4 = - � ? --- <br /> --------------------------- �� ° ------------------------------ ----------------------- <br /> ------ ------------- -------- <br /> ---- <br /> ------ ----------------------------------------------------------------------------------------------=--------------------------------------------------------------------------------- ------=------------------- <br /> -_ = <br /> Final Inspection. �- �- - Date.-__,__f/ -----------------__7_ <br /> p - ------- --- -- --- -------- <br /> --------------------------- <br /> ------- <br /> EH 13 24 _ SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M <br />