Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USES- <br /> APPLICATION FOR SANITATION PERMIT 77� <br /> --------------------------------- --------------------- (Complete in Triplicate) Permit No-------------- <br /> Date Issued//�_ 77- <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 Count Ordinance No. 49 and pxisting Rules and Regulations: <br /> JOB ADDRESS/LOCATION -�ofi! ----CENSUS TRACT----------- -------------------- <br /> /-! - m/6 <br /> Owner's Name--- ,tL'r�0_.-- <br /> Address-----------------�'QO-- LG�EsTGrg.tiee----------------------------- City- To-e'r ----------------------zip----- ----------------------- <br /> Contractor's Name__ ........-^[s'_------0^ =W tk;�_License #-_-_�'7C _ -�__Phone__44ed_ W�a <br /> Installation will serve: ResidenceX Apartment House Q---Co mmercial ❑ Trailer Court ❑ <br /> Motel ❑ Other_ ____ <br /> r '� <br /> Number of living units: Number.of bedrooms------------Garbage Grinder.___-_____Lot Size---.2_ Q0_____ _ __�S <br /> --------------- <br /> _ <br /> Water Supply: Public System and name----._.-------------------------------------------------___ �__G ____�-v ------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sanc4 Loam ❑ Clay Loam 9 <br /> Hardpan ❑ Adobe IAIFill Material----------- 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 [ J SEPTIC TANK Size___,. <br /> A q� - - Liquid Depth.s -----------3, <br /> Capacity_-�_N_D__d__�=Type_� -_6-A-Material_( .___No. Compartments.___�_______________ ' <br /> Distance to nearest: Well_- Y�_Crl'­X--______-_--_-____--Foundation_._ ___-_-___ -Prop. Line.__._:t©__ ____________ <br /> LEACHING LINE No. of Lines----(------------------------Length of ea-h line_ . ___© � Total Length ___-_ ___4 <br /> el{J --------- --- <br /> ----------------------------- ? <br /> 'D' Box------------Type Filter Material 1,C�`,_ �__Depth Filter MateriaLl.93_______________________-____ <br /> Distance to nearest: Well_m_R_Q1 A&__________-Foundation_.I_0.-________________'Property Line----Z- --___________-.--___._� <br /> r cr <br /> SEEPAGE PIT [ Depth�______Diameter___�g _____Number.-___1_____________________ I e( ocn Filled Yes X No ❑ <br /> 'S"` -'------------------Rock Size-- I- /Z- K 31 --------------------- <br /> Water Table Depth__ _-______ <br /> i <br /> Distance to nearest: Well__N_'--_-----------------------Foundation_ _©-_-__-_____.Prop. Line----cz�_____________.. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#_-________-------------------------------- ---Date____________________--___-. ) <br /> SepticTank (Specify Requirements)----------- ---------------------- ------------------------------------------------------------------------------------------------------------ ----------r <br /> Disposal Fietd (Specify Requirements)------ --------- --------------------------------------- ------- --------------------------------- . <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 agent <br /> signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> to become subjec o Workman'sTpmpensa!!J��of California." <br /> Signed---— —---`---- <br /> eF <br /> By------------------------------------------------------- - Title._ -- <br /> ir) -(If other than ow <br /> EPA tNT USE ONLY <br /> APPLICATION ACCEPTED BY-----------_ <br /> --- - - DATE <br /> DIVISION OF LAND NUMBER- -------- - - ------------------------------ ----------- DATE -------------------------------- <br /> ADDITIONAL COMMENTS------------ <br /> _ .d,_l - ------------- <br /> --------------------------------------------------------------------------------------------------------- ---------------------------------- -- ----------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------- ------- ------ -- - - - - ---------- ---------- ------------ ------------ <br /> FinalInspection by:---------------------------- ---------------------------- ------- --------t - -- - - - =-------Date---- -------------- <br /> EH 13 24 SAN JO LOCAL HE DI ICT F&5 21677 REV. 7176 3M <br />