Laserfiche WebLink
tQR OFFICE USE: <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> t (Coinplete in Triplicate) Permit <br /> .. .. <br /> ...... ... . ...... ........................... <br /> Date <br /> . .......................... .•.--..--...•--.._......... This Permit Expires I Year From Date Issued ...........­7. <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 existirIg Rules and Regulations: <br /> JOB ADDRESS/I.00WATI, N.......� ... .. ................._......CENSUS TRACT........ ............ ....... <br /> Owner's Name.... _c., <br /> r... ... 2'. . ..... ------11............. .... Phone............:: .................. <br /> --------------- <br /> Address. 17niu, <br /> ..... . . ....... ...city.. Yip--- .......... ..........+.... <br /> Cont <br /> ro' ctor'sA-,4t4AAC�.?.._A~. ..,..IJcense P`h _one. *T !�,qd,0.F <br /> 'IName_e1&4_. <br /> Installation will serve: Residence ❑ Apartment House [] Commercial Trailer Court E] <br /> Motel 0 Other..... .................... ........... <br /> ------- ---- <br /> Number of living units:.......!.Number of bedrooms_.. -.Garbe ge Grinder. j5Lot Size.__ -- <br /> Water Supply.. Public System and nom <br /> ......... ........I---------­-----....... ------------.,.Private <br /> Character of soil to a depth of 3'feet; Sand E) Slit 0 Clay E] Peat[I Sandy Loom E] * Clay Loom 0 <br /> -ti( P. . ............. <br /> e....... <br /> Hardpan 0 Adobe Fill Material.. :-. -:-.If yes,type..... ............ <br /> (Plot Plan, showing size of lot, location of system.In relation to wells, buildings, etc must be placid on reverse side.) <br /> NEW 'INSTALLATION: <br /> . {No septic tank or seepode .pit permitted if public sewer is available within 200.feet,j <br /> PACK 0lFTREATMENT—1 J—_SE_pTICfXff- KVSize..'­ <br /> .- - - 1 <br /> ..... .... <br /> CIcfDid-V6pfl .... ...... <br /> CoPaciy/2&d,6.f4Ty 61 <br /> m6t'eiiaufu,cC�.NoComparfmentsn-012--,... ................. <br /> Distance to nearest: Well..' A0. <br /> 1,9a.�........ ...............Foundation... ......._.Prop. Line.... ......... <br /> No. of Lines ....... .........Length of each line.... I...,�to t <br /> LEACHING LINE 9 �-ength 1'-'%... ..........­­11 <br /> 'D' Box...../ �Type Filter Materiol..,e&40_1t...Depth Filter Material_ tet.......,_....... ..... ....... <br /> ?...... <br /> Distance to nearest:,Well...1.0V.. ....Foundation.... . .............Property Line...... ................. . <br /> SEEPAGE.PIT ------- Rock`.Fille8 YesA I <br /> ye <br /> Water Table Depth._...... ........ ......................Rack Si .................;.i........... <br /> 4 <br /> arest! Well... <br /> Distance to new . --------Foundation--- ,........Pf:oip. Line... <br /> REPAIR/ADDITION (Prev.Sanitation Permit#----.-------- .................... .. ............Date...........•........ ................. <br /> Septic;Tank (Specify kequirements)....... ........... <br /> ...............=._.........:_._._...._.._..C.............. ............ ...... .............. <br /> Disposal Field (Specify Requirements!....:_..___ <br /> ........... ......­....... <br /> ........................... ................. ---------1�................ <br /> .............. ........ ...... ..................... ............ .............. ......................... .......... <br /> ......... <br /> ................ .......................... ......... ......... ....... <br /> 7---r--�---- ...........I.............. ....... <br /> (Draw existing 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.1 wifh. San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of theSon-JoaquinJocall Health District, Home owner or licensed agents <br /> signature certifies the following;` <br /> certify that In the performance of the work for which this permit is.issued, I shall notemploy,any person In'such manner as <br /> to become subject to Workman's Compensation laws of California." <br /> Signed_... ... -A)vvner CLARENCE'S SEPTIC & ftWER 'SERVICE <br /> k <br /> BY...................... 263 So. Oro # <br /> .......... <br /> ----- ------ <br /> 7 .09 Con roc or's'Cc: TTca <br /> (if other`than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..---- DATE ................. <br /> DIVISION OF LAND NUMBER-...-,......... .......1--2-1-1-111 ... . ....... . ..... ----------- -------- -DATE................................. ......... <br /> ................ .....................**.......*...... ............... <br /> ADDITIONAL COMMENTS._.......-............ .. ._.................. ...... ........... ...... ........ .............. .......... <br /> ........... ......I....... ................ ................... ................................ ......................................... .................. <br /> .............................. ....... ................. ....... ............—.............................. <br /> .................... ............. ...... ....... <br /> ......—---—------------------ ....... <br /> -tion by: ....................­­.­ .. ... ....... ....... .. .... .. _.__............... -----------Date...... <br /> Final Inspec ...................... <br /> EH 19 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21 W REV.7/76 IM <br />