Laserfiche WebLink
FOR OFFICE USE: <br /> FORG'FFC 'tC}SE: - APPLICATION FOR SANITATION PERMIT" 1 <br /> J Permit No..7_--- <br /> -`�- -- <br /> (Complete in,Triplicate) <br /> _ Date Issued__T2_--- --.- <br /> ----------- ----- '`" ti <br /> _-. - This Permit Expires 1 Year From Date Issued F x <br /> •--•---------- -- - <br /> �vf- lt����1 <br /> Application is hereby made to the San Joaquin Local H a t District fora permitTIO construct and install the work herein described! ; <br /> This application is made in compliance with County Ordinance No OSS ex ti Rules �Reg� ions: <br /> .�.�. . _� <br /> _ -------.CENSUS TRACT---------C.� -----��------ <br /> _. ------- -- <br /> JOS ADDRESS/LOCATION-__ ?- __.-----� <br /> Owner's Name ;.✓,�, �� Phone_ <br /> • .. <br /> � - — <br /> p �, -�5- ' _ ----------- --------------------------- <br /> Address..-- -- [ <br /> �(jj Phon "f <br /> Contractor's Name_. �i +C cense # <br /> ✓!Q `� <br /> _ Li - <br /> 4 > <br /> 11 Trai{�r ` T• <br /> Installation-will serve:' 7 Residence Apartment House.EComm a ❑ - ❑ 4 <br /> ��...,.Motel ❑ Other-=---- ---- �,_ `- =- - -'�-=-*'�"� f <br /> �ms. ---Garbage Grinder.__.__.--___Lot Size.-e- Private <br /> Number of living units:-�_!__.__------_Number ofbe°dro i j <br /> Water Supply: Public System.and name__.i ------- -- ----- ---- - f° j i" <br /> ---------- --- ------------- I.: <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Cla '❑ Peat❑ Sandy Loam Clay Lodni:❑ <br /> i <br /> p y <br /> Hardpan ❑ Adobe ❑ Fi1�l Matertial__..- If Yes. type �s <br /> (Piot plan, showing size of 14 location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> r.`,i L , , <br /> NEW INSTALLATION: (No septic tank or seepage pit-.pe;mltt d.if public sewer is ovailabl within 200 feet,]��j -+} <br /> i Cl ® Liquid Depth I-- ----------V <br /> PACKAGE TREATMENT [ ] SEPTIC TANK L 1 1 �' <br /> Capacity-. �. `' TYP <br /> e �?Z�hariai w �,No- Compartments_.____---: -:---- <br /> i r. <br /> 4 d <br /> tDistance to nearest: Wel;h_-----�:���-�- `;`==----- -------- Foundation-----�0--- - -----Prop. Line_-----�' -- ----- -----q,J <br /> g 1 ` �.�. - Total Length ---- ---a--------------- <br /> No. <br /> =-�--- - <br /> LEACHING LINE' [ <br /> No. o{f Lines--_-- � ------------Len'gJth o�ch h ne---- -------------- <br /> D' Box_"�"----Type�Filter MateriaL_.��--""".----:,Depth Filter Material_______"" . - <br /> J . Distance to nearest Well--- L----------------------Foundation_.___--fly- -`f ---.Property Line-------f- -=-} <br /> ---. <br /> l .� ---Number- S.- <br /> ... <br /> -------- <br /> PIT <br /> k Filled <br /> Ye N <br /> Roc i °❑ <br /> j PIT [ l Depth-./-e------Diameter_:_ --- --- r , 11 <br /> 4 <br /> �1 _ = : Rock Size------- <br /> Water Table Depths - <br /> l�S ati' res -� ------ Prop. Line-- k -G <br /> /� Distance to nearest: Wel'I_.- ----`+a--- <br /> ---�-'�`�`-Foundation---- ------- H <br /> ---------------- Date------- --------------------------- -- r. <br /> [ REPAIR7ADDITION•(Prey. Sani4ation Permit#_..____________ __ -I <br /> Septic Tank (Specify Re uirements):,.- - ------- = <br /> ------- <br /> pp p Y q q .1 <br /> kk { V _ ------------ �----------- `l <br /> Dis osal Field (SpecifyRe Require -_" � Y-:----- m j y <br /> � - ----t---- ----- ---------------------- -- ...... - - <br /> =. -- ------ ------------------------- -------------------- ---------- <br /> ----------------------------- <br /> -------- - <br /> r e side <br /> •,.�.;,.r.�-.-:..ass ---"-- <br /> (Draw existing and required ad-ition on.revers ) E <br /> lication and'that the work will be_done in accordance with San Joaquin County <br /> I hereby certify that l have prepared this app ' : , ,11 -6 -,� <br /> Ordinances, State Laws, and Rules and 'Reguldtion"s of ther'San Joaquin Local Health District. Home owner or licens'd agents <br /> I signature certifies the following: ���°' <br /> .� <br /> "I Certify that in the performance of thel work forzw.hich this permit igyssued, I shall not employ any person in such manner as <br /> to becomes ct to- Wo mans Compensate laws_of—California.' <br /> •� - <br /> �,1� ��'"r� _ ,? ,-I <br /> !Now <br /> ` nerr_ <br /> Signed = " -------- -- <br /> T i tl e- <br /> (if at}iera nowner) <br /> I FOR EPARTMENT USE ONLY <br /> ' - ---- - ----- -DATE._-L�`•+-1-- -��--- ------- <br /> APPLICATION ACCEPTED BY----- - <br /> a' ------------------------ <br /> I - <br /> --- -------------------------------------------- <br /> DATE <br /> DIVISION OF LAND NUMBER------------ ---- -------- ------------------ ---------- ------------------------------- <br /> ADDITIONAL COMMENTS--------------------- ---- ------------------------------------------------ ------------ <br /> - <br /> ---- --- - - ------ <br /> _ — <br /> ea <br /> - ----------------•---------------------- <br /> - <br /> ---- <br /> - ------------------------------- s ----- ------------------------------------ <br /> --------------------- <br /> --- - <br /> ---------------------- -- <br /> . <br /> - � --------------------------------Date-.�_/% .��---- ------- ----�-- <br /> Final Ins ection b !✓` '� ------------------------ T=;-----------------p Y'--'--- �� 5 F&5 21677 REV. 7/76 3M <br /> EH 13 24 ��l//�J SAN JOAQUIN LOCAL HEALTH DISTRICT <br />