Laserfiche WebLink
FOR OFFICE USE: Cir FOR-OFFICE USE: <br /> `APPLICATION FOR SANITATION,PERMIT <br /> ---------- -- --------- - ------ - 7 <br /> {Complete in Triplicate} Permit o.-.-"_.-__".-.:._.-"._- <br /> --------------------------------------------------------- e- -� <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: s <br /> JOB ADDRESS/LOCATION. 3 _ .%-+'-- ___.__ ._rx------- -------]_.__- }___.CENSUS TRACT------------ <br /> Owner's Name.:.... r OL o 1-7 --Phone- ---...- --`� (S.--------- ...... <br /> -�� <br /> Cr <br /> ... . ............ •----•--......-- •--..:.-•--•--...----- ---- - ----- ---- ---- ---- --- --- ---------- - ---- --- --"• • ••-•- <br /> Address = ` - -------------= ------------------- City Z <br /> i... . .. . T . -Itnr -loxr� 7 <br /> Contractor's Name-..--� -`----------- -=------•---•------------------ ------- ---license '#�`-'---�31`c Phone �`_ <br /> ___._�. <br /> M � <br /> Water Supply: Public system t1cemrnunity system ❑ Private ❑ Depth to Water Table,-:pft. <br /> .--• ,moi n r .1- 1..-.-�_ rt F`l_...L___.i-I <br /> Number of }ivirig units: _'_�__ _ Nutuber of.bedrooms- -_-= __Garbdge Grinder_______:___Lot Size___/__ .___�(__L'�v_______________.___.___._____ ___ <br /> Water Supply: Public System and.name ------------ ------ ------------ i----------------------------------------- ------------------------------------Private (� <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ ' Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> 'Hardpan ; Adobe❑ Fill Material-- -- --" _If Yes, type_-_.____.`-------------=------- <br /> (Plpt 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 tankr;or seepage pit permitted if public sewer is available within 200 feet,) a <br /> PACKAGE TREATMENT"-•[ ] SEPTIC TANK 1"1 Size----- r, ® " - -------------Liquid Depth.------ <br /> Capacit --_._,T e_ _ _ �+..'��C�!rys ia ---`---------------------No. Compartments.-`--------------------------- <br /> C <br /> _.Distance to nearest:.WelL-.......`------:-----.--•------------- Foundation--------------------------Prop. Line--------------------------- ------ <br /> fs <br /> LEACHING LINE. [.] No.of Li ......... ' ,_ .Length of each Iine.._s --------------------Total' Length._-- ----------------------"-"-"_:._ <br /> '= i <, '7 <br /> ..�" f �.. _ YP p.. Iter Material -;-----;= --------------------------------- ----- <br /> D' Box T e Filter,Material De th Fi <br /> J Distance to nearest. Well______________ Foundation-----------------------------Property Line.-__---_-"-_------.__ <br /> SEEPAGE PIT [ ] Depth Diameter T _Number- :__--_ t 4 Rock Filled Yes.J `' No ❑ <br /> �,• :......:.... .. - -- ------------------------------------------------- <br /> J+ Water Table Depth. __._ _ Rock Size � <br /> t <br /> REP tanceao nearest: Well -___ -- Foundation -._ Prop, Line-.--_"_--------------- <br /> -(Prev.-( ;--- -'----b =`=---=-.Date-- - ---------------------------------------- <br /> Septic <br /> ----------------------- <br /> Se tic Tank 5 eci# Re uirements ;.__ i_...:''..___:- == ----- ------------------ - --------- <br /> rev, onitation ermit <br /> ,Disposal Field,(Specify,Requ rements)`------=------ --- =------ <br /> 5----- .- ��. y <br /> ----------------------------------------- --------'----------'----------------------------- ----------------------------------------------- <br /> •-"._---------`.----`----`-`----" -=-----------------------'--------- -----------------------------------------'- -------- ---- -------------------"".---------------' --------. <br /> {Draw exis"ting 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 permiVis�issued, I shall not employ any person in`such manner as <br /> to become subject.to orkman'sOCompensation;.laws of California.'.' . <br /> Signed '� - " ' ---- - Owner r <br /> h <br /> A <br /> BY - - -- - - ------ ------ ------ --=- - � ._-_Title------------- ---- --- -- -- -- - ' <br /> If other thcin'owner _ ,... _ <br /> 3 <br /> F DE ARTMENT SE ONLY' <br /> APPLICATION ACCEPTED = ------------ <br /> BY-.- ---= - - -=# - ---DATE - ----- ---------------------- - - <br /> r " "' <br /> DIVISION OF LAND NUMBER------------- -----_ F <br /> s - -° DATE.s_. <br /> ADDITIONAL COMMENTS--------- --=- ------ ---- -`---` I - --------------------__--------------- <br /> ------------------------- _ <br /> -----'--------------------------------------------- ---------------------------------------------------------------------------`---------------------------------------------'-•--------------'---- <br /> = P ---------- <br /> Final Inspection ""�""_ ' == =_` - Date ----------------- <br /> P Y' _ _ ---- <br /> --- -- <br /> EH 13 24 N.JOAQUIN LOCAL HEALTH DISTRICT' " F&5 21677 REV. 7/76 3M <br />