Laserfiche WebLink
FOR OFFICE USE: ✓ FOR OFFICE USE: <br /> -...... <br /> FOR <br /> pM APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No.. .... 1©�.- <br />!: Date Issued <br />- •------ ...... ..... ............... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to.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 /> JOB ADDRESS/LOCATION ....... .t_ 1 .. hl- :.*F...�. ------ ----- - -----CENSUS TRACT....... <br /> - - --- <br /> Owner's Name.---N& �. ,_t-.1- ....... .......... ....... Phone. .,- .. ..^a. ... <br /> � ! <br /> Address-... .`"iE.�....o .- ....13 ..Cit .�.. ".� '� ,� <br /> zip - <br /> Contractor's Name......�„�.�,�"191 .._.. . . .. .. ,r.. License #- - - Phone.. .. . " <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other------------ ---------- -------- ------------- <br /> Number of living units:..-.-I..........Number of bedrooms-... .Garbage Grinder------------Lot Size--_..�.-1 .0- . ....--- <br /> Water Supply: Public System and name--------- --- ------------------------------------- ..... . --... ------ ------------------------------ --------------Private ❑` t <br /> p Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ v <br /> 1 <br /> Hardpan.E] Adobe Fill Material.. .... ....If yes, type----------------------------- - <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;] <br /> PACKAGE TREATMENT ( ] SEPTIC TANK [ ] Size...... --.---- ------_._.Liquid Depth-.---'----------------- - <br /> -Type--.............. ......Material--------------------------`--------- ---------- <br />� - Capacity -. ..------- - No. Compartments-------.:.------- - - <br /> Distance to nearest: Well.-................ .. .........Foundation.......... . ..._- Prop. Line... <br /> r <br /> LEACHING LINE ( ] No. of Lines ................. ...:.... Length of each line..........................._. Total Length .. .... <br /> D' Box............Type Filter Material------ Depth Filter Material------------------- ---- ---------------------------.JoEO] <br /> Distance to nearest: Well _...-..-._.,_ _........Foundation------------- - - -Property Line...i.----------.---------SEEPAGE PIT ( ] Depth--,. ----- -- Diameter--------------------Number-.--------- -----. Rock Filled Yes ❑ <br /> Water Table Depth------------------------------- ------ --- ----------Rock Size-- .................................... .... <br /> Distance to nearest: Well----------...---......----------------------Foundation.-. . .........Prop. Line-------------_--_------. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#......................... ...... . ......... Date--..------------- -----] y—= <br /> 1 � .. <br /> Septic Tank (Specify Requirements).................. ............................ - -- --------- -- - -----........,... -....... ......................... ...... <br /> t Disposal Field (Specify Requirements)._._.._ :.0- - --- = ------ _r..-.- - <br /> -q <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 />! <br /> -I ce ' that in the performance of the work' for which this permit is issued, I shall not employ any person in such manner as <br /> I to beco subt �C�pesalionWo c a1 Paws of California." <br /> Signed._.._ OwnerAA <br /> By.................... .................................. Title -- . ------..-.._. - <br /> (If other than owner) <br /> FOR DePAR4MfNT JJJE ONLY <br /> APPLICATION ACCEPTED BY... /`'° '^ --... ---------------------------- ---..DATE :.39./..,? <br /> DIVISION OF LAND NUMBER............ .. ----------- -----------------DATE--- ----------- ---_-------- ...... . <br /> ADDITIONAL COMMENTS.......... - -;- __ --....... <br /> ............. -- ---•_.................... ••-----------.-..... <br /> ---------•------ ---- -- -- ... .. - n - <br /> ---- <br /> ..Date...97-,�.... <br /> Final Inspection b -- . .... .-.- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV, 71763M <br />