Laserfiche WebLink
s� _r.,�,.e�� --•�—�o--�smr��ir.�arrges.fa.--msc�.- — <br /> FOR OFFICE USE: � FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .......... ----------------------- -- ---- _. 4?1 _S <br /> {Complete in Triplicate} Permit No-------------------- <br /> " Date <br /> •-••••-••-••••----•---• ............ This Permit Expires I Year From Date Issued <br /> Application is hereby made to.the San Joaquin Local Health District fora 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 /> JOB ADDRESS/LOCATION_... Ff <br /> - -_--.-. 2%5 <br /> RSO ,�� <br /> . - ------- ----- -----------------.....-- •------------------ --CENSUS TRACT..................... - .....- <br /> Owner's Name --let> R&C M 0%,u Phone c.,. <br /> ••----- -------------- ------ -------- ----------------- -------­--------------- --- - . <br /> 9 .2g P)c Ar>~�� �I►fA �Trr <br /> Address.. - <br /> -------- . --- ------ -------- Cit <br /> - ------------ --- ---- ----------- -- .-.-.--- - City--- --ZiP------------.._....---------- <br /> Contractor's Name._..-.�AR6+�� License #_-_-2y ` � .._...Phone._.�A''S6Sfy <br /> -- ----- -- --- •-. <br /> Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel..`❑ Other- ---- ------------------------------------ <br /> Lot <br /> ---------- ------ ; <br /> Number of living units: of bedrooms_.- .---_.- Garbage Grinder Size._____... ...... <br /> g <br /> Water Supply: Public System and name---- .............. ... '• . --------Private ®-' <br /> Character of soil to a depth of 3 feet: Sand [I?(' Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material - .... ....If yes, type..................... .-.- <br /> . <br /> (Plot 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 public sewer'is available within 200 feet,) i A <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size.- -.-J O;: .- ... '._- <br /> Capacity— <br /> ............Liquid Depth.__-: )1`"-.�e. v� <br /> .. -.-� <br /> Capacity-.-j2n� ----_Type_-• � -.--Material-- '!+a .3T`.---_--.No. Compartments...._____________ <br /> Distance to nearest: Well_...._-�.r' -`--------------------- -----F uo ndati.on_•-__-�_?I....._.....-.Prop. Lines ..S._i <br /> .......... <br /> -_--- . <br /> LEACHING LINE ----- `761 e ' 1 2 Id' <br /> [ ] No. of Lines ---..... ---.Length of each line ------------------------------Total Length - ----.--.-.._.-_--._----__--_-__--_ <br /> 'D' Box_...1-:...Type Filter Material_...� �. --..Depth Filter.Material---. 1 --------------------------------- -----------------_- <br /> !c <br /> Distance to nearest: Well------- .................. Foundation--,---•---•-•_---------.....Property Line-•-----------................. <br /> .._. <br /> SEEPAGE PIT [ ] Depth--........ ..Diameter-.-_---_---_---._---Number-----------------------------Y Rock Filled Yes ❑ No <br /> Water Table Depth- ----------------------------- ---•-----Rock Size--------- '.--.-. <br /> stance to nearest: <br /> REPAlR/ADDITION Prev.DSlanitation Permit#Well.-----•------------- -- ---- ---- ----------Datedation-- .:.'•....Prop• Line............-------.--__--- <br /> ( --.-_....) <br /> Septic Tank (Specify Requirements)------ - --------------- ......... ..... -------------------------------------- .. R---------------------....... ..---.---- . 4 <br /> Disposal Field (Specify Requirements) ------........... <br /> ­­..... -------------- -- .......................................:. .. ------ ............. .... ......... <br /> --------------- -------- ------------- ------------------- ............ <br /> ---- -- - <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies 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 as <br /> to become subject to Workman's Compe ation laws of California." <br /> Signed.,------- <br /> �--�.....- Owner r <br /> By................. - -�+-i'�'' -­-.....Title - - -- --- --- ... ... . -- - ------- - - -•-- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------. ............... .............DATE .-_-- - -- ------- ----- -------- <br /> DIVISION OF LAND NUMBER.....- ----------- ------------------------ -- -- --- ......... DATE.... ..................... <br /> ADDITIONAL COMMENTS------- --------- ---- I <br /> ------------------- ................. ------........... -------------- --------------•------------------------- ­-------------- ................. <br /> -------- -----------• ------------------------ <br /> Final Inspeci•1on b �. �r'.,"." - ----- ----------------Date....-V <br /> ----- <br /> EH 13 2" SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F8.5 21677 REV, 7/76 aM <br />