Laserfiche WebLink
FOR OFFICE USE; <br /> . / , APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> ..... ...................... 4, <br /> --------_---------- (Complete in Tripliiate)'_-'4 Permit No.?... 4 <br /> .........I------ ------ <br /> ....... This Permit Expires I Year From 'Date Issued Date <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 Ord' once No. 549 cind existing Rules and Regulations; <br /> JOB ADDRESSAOCAT <br /> Owner's Name._. . J <br /> - -- - ----- ......CENSUS TReACT:.. <br /> ... ..... ... . <br /> Address.-.--- <br /> - ---- ------C1 <br /> Contractor's Nam <br /> --- ---- ....... ..... ..... --------License # <br /> _.;.f one49 <br /> F Ph <br /> Installation will serve-.- -Residence [�9Apartment House ❑ Commercial ❑ Trailer_-.Court <br /> ❑ <br /> d Motel ❑ Other---- .....--- <br /> Number of living units:.. <br /> 7.­._-_Numb1er of bedrooms...C;L Garbage Gr,'nd2--_--------Lot Size.... ---------- .... .. <br /> Water Supply: Public System and name I------- -----------7777�1 <br /> a ........ <br /> ---------Private E] <br /> ------------------------- -------- <br /> Character'of soil`to a depth of 3 feet; Sand ❑ Silt El 00Y ❑ Peat 0 Sandy Loom E] Clay Loam <br /> Hardpan ❑ Aclobe�Nr" Fill Material.. .... ....If yes, type....... ........................ <br /> (Plot plan, showing size of lot, location'of s <br /> ystern in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION. (No septic talk or seepage pit permitted i <br /> ed if public sewer is available within 200 feet,) <br /> SEPTIC TANK <br /> PACKAGE TREATMENT Size...... <br /> ---i-------------------------------- .1---------Liquid Depth.--- ........ ......... <br /> capadty_ .......I- ---------Type:-------------- ------Material-4^'-----------------------No. Compartments------=-- ...... <br /> t "I i -------- ----- <br /> Distance to nearest; Well...... F&ar <br /> .........__..... <br /> ------.... -idation.......... . . .,..,.Prop. Line- 0 <br /> -- --- <br /> LEACHING LINE No of <br /> A Lines =.----------------------.Length of each line- .----------- ... Total Length <br /> ---------- ------------- <br /> 'D' Bo_x_. Type Filter Material.....................Depth Filter Material.........--...._... ------------- ------------- <br /> Distance to nearest: Well................__...__....Foundation.-------_- -----------Property Line .-:-------------- ------ <br /> SEEPAGE PIT Depth.....-------- <br /> -,Diame'ter....................Number_---------------------------.--- Rock Filled 'Yes E:1 No <br /> I ❑ <br /> Water Table Depth....I--------------------------­-- ---------------I---- Rock Size..... <br /> ----------- <br /> Distance to nearest: Well-------- -- -----------------...Foundation...........-- ....... Prop.-Li!he -------------- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#...t........-- <br /> - ---------------Date--- --------------- <br /> Septic Tank (Spedify Requirements)---- <br /> I ---------- --- ------------------ -- ---------- -- ------------ -------------- <br /> --------- ---- <br /> ents, 6�,- — <br /> Disposal Field ecify Requirements -- ------- <br /> --------------- ....... ------------- <br /> ---------------------------- ........ ......... --------- 7 1 k <br /> ------------------------ --------- ------------- ---------- ---------------­ ..... .................. <br /> (D(6w,existing and required addition on reverse side] <br /> I hereby certify that I have,prepared this application and that the <br /> work wiltbeRdone in.,accor'dance with Son Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the 'San Joaquin Local 1-16alth"Idis'tricti-. Home owner or licensed agents <br /> signature certifies the following: <br /> "I certify that in the perforrnancdmcof the work for which this permit is issued, 11"'shall nof';mplay any person in such manner as <br /> to become s e o orkrr. A 1pensation lows of California."' <br /> Signed...... <br /> u 'CoC W-r -------- <br /> --- -- ----- wner <br /> By----------- -------- --------- --- 1`0 <br /> . ......... <br /> e .owner[ }[ <br /> (If other than oowner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> ---------- ...... __.DATE ........ <br /> DIVISION OF LAND NUMBER.------ -- ---- ---- ------------------------- ------- ......... . ----I----------- ---DATE------- ----- <br /> ADDITIONAL COMMENTS <br /> ............... ------------- <br /> . <br /> ------------------------ ......... .......... ----- i <br /> --------------------- --- -------- -------- ...... ..... <br /> ---------------------------------------- <br /> - --- ------------------------------------------ <br /> FinalInsp' �- — ------- -- ---------------­­_­--------------I----------------------------I.....­----------------------- - <br /> e'tfion by;... ....... ...... ------------- ------ -------------- - ------------------------------------Date ...... <br /> ------ <br /> -- _ <br /> EH 13 14 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT )677RFV, 7/763_M <br />