Laserfiche WebLink
a I <br /> FOR OFFICE USE: FOR OFFICE USE- <br /> ---------------- <br /> SE: <br /> �i APPLICATION FOR SANITATION PERMIT <br /> - - --------------------•------------- --- - Permit <br /> i <br /> (Complete in Triplicate) '` <br /> --------------------------------------------------------- <br /> i Date <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> �i <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, c <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations fi T i fi <br /> �� 11 1 n. <br /> JOB ADDRESS/LOCATION -,"'11'_. _'1 -_ _ _ _57,N C.(`1-_ --c� :. i . -_� t .__._CENSUS TRACT ................ --- <br /> _ - 1 r <br /> Owner's Name :. _C? -------------------- n - -`� �, �' C" �" Phone- <br /> -, r, " W 1 <br /> Address._..c5_ ._�. � ' i - -- -----='Cit .rCs.--c-- ----- ------- ----Zi <br /> .J17' i Y p 7 tiP <br /> Contractor's Name._____ _ ,__ i� f rV_.N_is. ._.__ : License #_5 __ Phone__ <br /> Installation will serve: I`ilesidence ��Apartmen� ause �'� Commercial ❑ Trailer Court ❑ <br /> f Motel O leer -- - <br /> t t <br /> Number of.Iiving units:_____.,------'_Number of..bedr so -, G` r age Gtind f.-----}--Lot.Siz .___.__.1. y'f-_ .__ll•---------------_. i <br /> t <br /> Water Supply: Public System.-and name---- ) ........ <br /> y=--------------- ---------------- ----Private M <br /> .`y; �►j <br /> Character of soil to a depth of 3 feet; " Sand [] Silt y� at Sandy Loam ❑ Clay Loam ° <br /> s p ❑ ,, ❑ - 1y } .. <br /> Hard an obe �] -�eri' e5;t~pe = ] <br /> 24 <br /> [Plot plan, showing size of lot, locati n of sy to m re do tv II's; u7ldings,.e#c. must be placed on reverse side.) „� <br /> NEW INSTALLATION: [No septic tank°or pag pi permitt[ if public sewer is available within X00 feet,] } <br /> PACKAGE TREATMENT [ ] SEPT C TAMC ]" t Size_--_- __ --------- { Liqu'idrDep'fh:_'_'""'_ ____ - <br /> + Capacity_ p? = Materials ±ompartmeyn_t `; <br /> . . <br /> . % ' Distance t ne st: ell .,, __'____. ----- -_Fa ncfatio _ Prop' Line.,.] <br /> u +. <br /> LEACHING LINE, [..] No.. of Lines,=____�-�_. _. Length of-each line------- Q _E Total Length 'Q 17 <br /> . <br /> ` o l :1_rc,� �d r alr <br /> D' Box'.1 -.'-_Typ Fil er MatericlI _. epth Filter Maferral ___ ----O_._�____ '_r - <br /> Distance•to neares : Well____. d4_ Foundation '�L? Propefty Line - -_ __ w <br /> Water '--- -- -- -Di meter-------- -----------Number._--._------._ -.-__ Rock Filled Yes ❑ I Nc❑ <br /> SEEPAGE PIT [ ] Depth--:-. y- _ ` <br /> TableDept --------------- ----------- ------------- --Rock Size------------------------------------ ------- <br /> (Prev. ion Permit#�-,... =-�=-=�='-'-- -----'- - c--=__:_ = � -- ------------_------ <br /> .. <br /> REPAIR/ADDITION Prev. Sanitation to nearest: ell-__. Date�ation_- <br /> -�---•=----------------Prop. Line <br /> Dlstanc <br /> Septic Tank (Specify Requirements) '-- - =---'--------==---=-=--- ----- - <br /> - <br /> i <br /> Disposal Field {Specify Requirements} ___ r -'------- <br /> ----------- ------------ <br /> ----------y-------------------.----.-----------i--------------------- --------------- ------------- ----- - -- --------------------------�---- - - ------ <br /> 4 <br /> • <br /> ---------------------------------- ----------=------------=- ---------------- -------------------- ------------------- --- --- <br /> g {Draw existing and required addition on reverse side) r _ <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 permi4 is issued, -1 shall"not employ any person in such manner as <br /> to becomes le m p, <br /> Signed:--�\...Y----- ----- -- <br /> By------------------------------ <br /> ------ - ---� --�_ --- - - <br /> �tj _to.Workman s om ensation aws o a i ornia. <br /> BY --------------------------------------------- ------------------- --- --- -------------------------------- <br /> [If'other' than•owner) ` ) <br /> } II F 'DEPARTMENT NLY' t. <br /> APPLICATION ACCEPTED 'BY 4'- I <br /> DATE....---------- <br /> DIVISION OF LAND NUMBER.-:.---- ---------------.---------------------------- .: :--.-:------ ----------------------------- DATE----------------------------------------------- <br /> ADDITIONAL <br /> -------------------------ADDITIONAL COMMENTS-----`------- x------ :------------------------------------------------------- ---'------------------- ----------------=-- --- _----------- <br /> ( ------------------- <br /> --------------------- <br /> --- - ------ -------------- - <br /> -- - - ----------- ------------_ ---- <br /> ------ �:: : <br /> .. ., .. <br /> ---- ------ - <br /> ----`--------------- ._------------------.__ <br /> ------------ <br /> Final-insection b . f °:"` _ _ ..._ .._.,.: _ — ------------ --------------------- ---- --Date ----------------------------------- ----------- <br /> p . <br /> EH 13 24 - ` �� SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 21h77 aev. ���6 3M <br />