Laserfiche WebLink
. i <br /> [CE,Ucr- <br /> APPLICATION FOR SANITATION PERMIT <br /> FOR GFFn <br /> Penkt No. 'J`�r�� •• <br /> ............. <br /> --- -- ;Complete in Tri <br /> piicatei <br /> ...2, ....... Date issued ..7:�-•-••.`'•�-. <br /> zThis I'ermlt Expires 1 Year From Date Issued <br /> .... .,. permit to construct and install the work herein <br /> $" Application is hereby made to the Son Joaquin Local Health District for p <br /> fication is made in cam lienee with County Ordinance No. 549 and existing Rules and Regulations: <br /> described. This app p , „_CENSUS TRACT ............ <br /> e <br /> r _ _ <br /> JOB ADDRESS/LOC�i'ION, ...]............ ... . <br /> :7. _..�1-.l, ..... ............. <br /> c c .. <br /> . Phan •, � '-�.. <br /> 3 . Owners Nome .1.. �..-.:�:J.J..�.. _ �. ....... _ - <br /> Add ` ... r Phone <br /> f Cty e / ��. <br /> rens ... -�r.�. .._..4 y <br /> - icen <br /> Contractor's Name...._ Trailer Court 0 <br /> lnstaklation will.serve: Residence[RApartment House El Commercial ❑ <br /> Motel ❑Other ..-. <br /> r -.-........_ Lot Size <br /> ?' <br /> Number of living units::....r-.-. Number of bedroom a _.........-.Garbage <br /> Grinder <br /> private Q <br /> ' ...................... ... . ........................................................... <br /> N l Public System and name ...................... i <br /> Water Supp /: peat❑ Sandy Loam Q Cloy Loam ❑ <br /> 4 r <br /> Character of soil to a depth of 3 feet: Sand© Silt❑ Clay ❑ <br /> . _ <br /> Hardpan❑ Adobe ❑ Fill Material -.-...... ..I, yes,type----- <br /> ................ . <br /> ----- <br /> '"`'� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse <br /> side. <br /> " it permitted if public sewer is available within 204 feet, <br /> NEW INSTALLATION: (No septic tank or seepage p' <br /> Size...... ...:...... ................ <br /> ....-... Liquid Dor.-'h .......................... <br /> SEPTIC TANK[ ] <br /> PACKAGE TREATMENT [ ater,ol . No. Compartments <br /> Capacity <br /> Type ..._....... . <br /> r Foundation <br /> ...................... r Line. <br /> ~'.. <br /> _ .._.F <br /> Distance to nearest Well <br /> •�,;; ................. Tota Length ........................... <br /> .. Length f eac line.... ..... S <br /> ra <br /> LEACHING LINE ( ] <br /> No. of lines ...... .:..... ....... ..... <br /> ...... . ..........Depth f=ilter Material ...................... <br /> 'D' Box ..._... ... Type Filter Materi Property Eine <br /> . <br /> Foundation ................ <br /> Distance to nearest: Well ....._... No <br /> b Rock Filled Yes ❑ <br /> Num e, <br /> SEEPAGE P'_ '[ ] Depth ................... .._. ................... (o <br /> Water.Table Depth .------- <br /> �� Rock Size ..-•••-•• _-•• [ i <br /> -. ......... Prop. Line .................. <br /> .. Foundation <br /> Distance to nearest: Wel -..-- - <br /> ............. <br /> a <.` to ............................... 1 <br /> ,. <br /> Sonication Permit# ..........�.................. . <br /> REP�ADDIT!ON(Prev. ............. <br /> i Septic Tank (Specify Requirements) ..... .----.-_................. ... <br /> x}.. <br /> _.-. ....... ........ <br /> pecif Re uireme sj •.....•..............,- 7....._ r / �� ........... <br /> Disposal F IS IS Y q - ....... ............. . ..... :::._._..................._..............._..._ <br /> f uL <br /> . x/S !L <br /> Iy,; '}. !' _int ___ <br /> ...................... ........................ - <br /> (Draw existing and squired addition on reverse side) <br /> application and that the work will be don* in accordance with San Joaquin <br /> •1=,":; I hereby certify that I have prepared Ibis app' <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Renta owner or 11can- <br /> +es the Following: errttiit is issued, I shall not employ any p <br /> crson in such manner <br /> sed agents signature certif <br /> "I certify that in the ,>,rformance of the work for which this p <br /> ` ""• as to become subjeci :1 Wor rmn's Compensation laws of California. <br /> wner <br /> s <br /> Signed ...-�� --•fie .........--•- . <br /> •.[�./. <br /> t By <br /> (If other than owner <br /> FOP. DEPARTMENT USE ONLY <br /> .�— - DATE .... - '........-....Y.......... <br /> -� _ <br /> APPLICATION ACCEPTED BY... .............. <br /> BUILDINGPERMIT ISSUED ...................................... I.......:...._........_...._........... .--•--•.....:..........--DAT...- ...................................... -- <br /> ......... ................... <br /> = ADDITIONAL .COMMENTS.. ....... <br /> y.. <br /> 'f <br /> ..................... ..•- •:-................-............................-.. .�.�................... <br /> ..................... ..._.....................--Date..... .. .. <br /> ,r f. .... ................ <br /> Final Inspection by: ..- - -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H• 9 1,'68 Rev. 5M <br />