Laserfiche WebLink
{ <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> -- •....................... ...•--- Permit No. .7-�.���7� <br /> 9 ��� (Complete in Triplicate) it <br /> ((......._.... ...................... <br /> This Permit Expires 1 Year From Date Issued Date Issued .�..�-........ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations. <br /> 4{`1 _,C � I <br /> Ri � ar�r.-'a k -�• it i 111. i <br /> J013 ADDRESS/LOCATION "...... ......... .._...... . ... . . CENSUS TRACT .......................... <br /> -... .... ...... .... F <br /> r <br /> Owner's Name .......KN�d ,•_. cccs.f�f cn+ro 4...... vin. ..:------ Phone . '. d.. <br /> Address -RD Cites .rJ.............................................. <br /> Contractor's Name -----�,. .... ► .h.-" .- u`a,---�`._�._. ....----------.License # Phone (� 7---- <br /> Installation will serve: Residence 2S Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other .. cDP.4 ...1 <br /> Number of living units:....__.,. Number af-bedrooms ..q.,___.,Garbage,Grinder €_... LotSize _.r '� !r_ ..- <br /> Water Supply: Public System acid name ._--------------- -•---- -••--.......---- ------ --.._....... --....-----------.... --------•-------......----Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt;(] ••Cloy Vq •Peat❑ Sandy Loam ❑ Clay Loam ❑ -� <br /> . O <br /> Hardpan Adabe,❑. FIII Material ............ Ifiyes,type ...._..._....._._... ------- <br /> � <br /> (Plot plan, showing size of lot, location of..system in-relation to.wells, buildings,.'etc. must be placed on reverse side.) Vi <br /> NEW INSTALLATION: (No septic tank or;seepage pit permitted if public. sewer is available within 200 feet,) kA <br /> PACKAGE TREATMENT [ } ' ,SEPTIC TANK Size.....I&Y:,._ .. <br /> --•- . . .............. Liquid Depth ....��. �.........----- <br /> Capacity . � : ;_---- Type _ r - _ Material... " ' ° No. Compartments 5A-..--------- •-•-� <br /> Distance to nearest: Well ---------...........Foundation ------- Prop. Line ...................... <br /> LEACHING LINE (;k No. of Lines _. .. Length of each line ......_4D... ...... Total Length, ._J- .............. <br /> 'D' Box ..73.,�. Type Filter Material iL.�7�-----Depth Filter Material ..../�� ....................... <br /> ........ <br /> X <br /> r <br /> Distance to nearest: Well ._.. `.' ...._. Foundation .. ...fa ' �- --- Property Line AF_..............n <br /> SEEPAGE PIT Depth . �: Diameter _..L ._--- Number ... .._ ......_.... Rock Filled Yes No ❑�. <br /> !` <br /> Water Table Depth :.:.j--7 .r-------C-------------------------Rock Size ,.... .... <br /> Distance to nearest: Well .._ _L b_' ..............._.---Foundation ._._�a.r.�`... Prop. Line .�""rte VV <br /> •-- -- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .."-------------- ----- ........... Date --.-------_---.....------------.I <br /> a <br /> Septic Tank (Specify Requirements) ..,. .. .. ............. ------------------------------------=--------------------•---................................ <br /> DisposalField (Specify Requirements) --------------------------------------------------------- -------------------- - --- --------------------------------------- <br /> -. .A, ...............................................................1.................."--•.._. .......... <br /> ......................... ..... ....... -_.-.-...-- --....................... .........- ---------- ----------..._......-- .... ......................_.._.....----•--- <br /> ,. :(Drdw existing'•and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licen- <br /> sed agents 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 <br /> as to become sub'ect to Wark n`s Compensation laws of California." <br /> Signed . - ...................... . ................................ Owner <br /> By __ . .. ...... ... .. Title . . <br /> ( other than owner) <br /> FOR DEPARTMENT USE ONLY� � <br /> APPLICATION ACCEPTED BY ... ...... ..............................................---------. DATE .._b. a .. ... <br /> BUILDING PERMIT ISSUED ................. . ........... ... ................. . ------.DATE <br /> ADDITIONALCOMMENTS ................. --- -------------------------------------- --.....-------- •-- --------....------.............................................. <br /> f --------------I------------------ .................. ---------•----- ..................... ------ -------------- .........---.............. ..................".._..--. <br /> -•........................­ ..._..... ---------------------------------.I_..,......_........- --• •_-...----.....---•---•--.....-- ......---- ----...------........ -----....._......._... <br /> ............. ........ . <br />` Final Inspection by: -- --- --mil - Date /. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT .:z <br /> 7179 'A M <br />