Laserfiche WebLink
FOR OFFICE USE: <br /> Ik I Al, CATION FOR SANITATION PERMIT �! 5 <br /> ------------------ ---- ----- Permit No. ..�72--__ -----.. <br /> l (Complete in Triplicate) <br /> f'----------------- -------------------- -•------ <br /> Date Issued <br /> ----- This Permit Expires 1 Year From Date Issued <br /> pplication is hereby ma e tot eeSSaan o uin Local He Distr' for ermit to construct and install the work herein <br /> escribed. This application is mad e/ir!tqqee wit _ a lto. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION.- --CENSUS TRACT ............. . <br /> --------... <br /> IFti Dwner's Name � ��/1Li�c r=✓ <br /> ..-_. . -•---- .--- <br /> --- rPh <br /> one <br /> f' ---------- <br /> 4 <br /> City ` c'rAddress _ -- -------_. <br /> t_"1. -- --------License # /Ax-7� Ph <br /> one --------- -----------------•- <br /> ontrictor's Name r-r <br /> stallation will serve: Resident ❑ Apartment House ❑ Commercial ❑Trailer Court 0 <br /> Motel ❑ Other ------. <br /> -- <br /> ,lumber of living units:............ Number of bedrooms -_.---------Garbage Grinder ----------- Lot Size ------- .__.._--...______.._..- ------- <br /> Nater Supply: Public System and Warne _____________ �z rJ" `" `�' Private <br /> pp Y= y �? ❑ <br /> haracter of soil to a depth of 3 feet; Sand❑ Silt❑ Clay ❑ Peat 0 Sandy Loam e Clay Loam ❑ <br /> i <br /> Hardpan ❑ Adobe ❑ Fill Material ----- - if yes,type ---------------------------- <br /> Plot <br /> ------------------------_Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> i4EW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK i ] Size-------------------------- ----."--.--- -7- - Liquid Depth -------.-_------------ <br /> Capacity <br /> .-- -- <br /> Capacity -- -- ------ -- --- Type -------------------- Material_-------------.._.._ No. Compartments -----_---•----...... <br /> Foundation ------------------- - Pro . <br /> Distance to nearest: Well ..________....._______________ _ p. Line _._._.__..... -------- <br /> r�EACHING LINE [,] No. of Lines ------------------------ Length of each line------.-----------:.......... Total Length ----------------------_---- <br /> D' Box ------ .... Type Filter Material --------------------Depth Filter.Material -.---..--.----------.----------..-..._-_--_- <br /> Distance to nearest: Well -------- --------- Foundation ...-_-------_----------- Property Line ---._____.._---.---..___ <br /> [�] Depth __..-7 ?..__._--- Biometer '-k--RC1_ Number ----------- --------------- Rock Filled Yes {A No ❑ <br /> i Water Table Depth -------- "-- -------Rock Size 1 ----­--------------- <br /> Distance <br /> x 3 ' <br /> Distance to nearest: Well ---------- _'__________________Foundation ....IV..._...___ Prop. Line ----5-----____.___.. <br /> tEPA1R/ADDITION(Prev. Sanitation Permit# ----------------------------------------- -• Date ---------------------------------- <br /> Septic Tank (Specify Requirements) ........ .. ........ ...... <br /> isposal Field (Spcify Requirements) - - '- - --- -- <br /> F_ -------- <br /> ----- ---------------------------- ------- ---------------------------------------- ---------- ----------------------- <br />� (Draw existing and required addition on reverse side) <br /> 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 />` {ed agents signature certifies the following- <br /> -1'1 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 subject to Workman's Compensation laws of California." <br /> igned ---- ----------- -_ ------ Owner i <br /> Title <br /> ,yam-,�]�. d.�� e . -1Fa-� <br /> y -------------- --------------------- ---------=----------" ----- -------- ) ------ - ................ .............. <br /> (If other than owner) <br /> ;fOR DEPARTMENT USE ONLY <br /> FaPPLICATiON ACCEPTED BY -�- � -- -- - -- - -��-------------�--�-�---�---�---�---�- - - ._ DAT); -—__------ <br /> BUILDING PERMIT ISSUED -------------------------------- -- --- ---- ------------ ------------------- ---- -- DATE ...... --- <br /> DDITIONALCOMMENTS ---------------- ------- ------------------------------------------------------ ----------- ............... .................... <br /> --------- -- - ------- ------------------------------- --------------------------------- <br /> ----- <br /> mal Inspection by . . •---.-- . --...Date d�. °: ...... ............. .... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />