Laserfiche WebLink
FOR OFFICE USE: <br /> ................ APPLICATION FOR SANITATION PERMIT FOR OFFICE USE; <br /> O% (Complete in Triplicate) ��- 3 q <br /> -�--•-----• � --- ��---- litPermit No..._ ..-_ -•---- - <br /> ------ ------. .. This Permit Expires 1 Year From Date Issued Date Issued�".rp.-7.2 <br /> Application is hereby ma <br /> This application is madede to.the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> .in complionce with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATiON_..I- /�UE <br /> s . <br /> ! -------GENS S TRACT.._.. <br /> Owner's Name.... .. ljQ�?.. Vr_{ (T a&2... _ <br /> .................. ..Ph <br /> Address 0 wq- , one.... ._... .. . �.�D . <br /> BZ / <br /> - --- <br /> .City--- :7Ck7- •t1 <br /> Contractor's Name.-..--- --- -- 2fJ/ � `. `� p---�- - ------------- - ---- <br /> 4 - -- ---------License #. 5--.._,37`��_.,..Phone- - . ..- ---•-- --- - <br /> Installation will serve; <br /> Residence Apartment House ❑ Commercial ❑ Trailer Court <br /> ❑ <br /> XM tel ❑ Other,-: �_. . <br /> •'units-.. <br /> / nNum-ber-of bedrooms 'n -Garbage-Grinder=- �L•at�5ze=:_Number of living <br /> Water Supply.. Publics stem and nam ...... -- Tz"e . . 5 -XJA$:W-_.- <br /> ._... <br /> i <br /> -----------------------•-----------.- ----- Private ElCharacter of soil to a depth of 3 feet:. Sand Silt <br /> l ❑ ❑ Cla y ❑ Peat ❑ Sandy Loam ❑ Clay Loom ❑ <br /> Hardpan ❑ Adobe fFitt Material.. ... _..-If yes, type............................ ' <br /> (Pint plan, showing size of lot, IocatiorF of system'in relation to wells, buildings, etc(must be-placed on reverse side.) <br /> NEW INSTALLATION: {No septic tank or see a e` it <br /> I p g, A permitted if public sewer is avail'ab'le within 200 feet,) <br /> PACKAGE TREATMENT f ) SEPTIC TANK "' - <br /> ( Size . ....... ------- -------.. -----!'Liquid Depth.--- .� <br /> Capacity- ....._. - Type-----•. .. .... .:....Moterial - <br /> ..No.,Comp Compartments ------... <br /> ------------ <br /> Distance to nearest: Well--------- Pro <br /> --------- :- Foundation__-- -- t <br /> --- p. Line_.. <br /> LEACHING LINE [ ] No. of Lines ..... ......... ...... ....Length of each dins,.------------- <br /> ------••---- :`'Notal Length �.. .:-- ---------- - - <br /> 'D' Box.... .......Type Filter Material. ___ u i. : 1 T <br /> ---.Depth Filter Material------- -- <br /> Distance,to nearest: Well----,----------------- ---...Foundation.........-....--- ---..`?'Property Lina-..--------'.............. <br /> SEEPAGE PIT . r-, .. ..._.. <br /> f Depth.... Diameter -. Number-.-.. - "" <br /> -- :Rock Filled Yes ❑ No❑ <br /> Water Table Depth ......... ... ----- ---- ---------Rock Size.... . . <br /> Distance to nearest: Well.......... ....: . Foundation._._......`-_ . . _... <br /> ...--. Pfpp. Line__..... . <br /> REPAIR/ADDITION (Prev. Sanitation Permit#........_.f. -- ....... --` "�w -f--------- D a te. 6�,1'e, ?. _ <br /> _...•" .......... ....... <br /> Septic Tank (Specify Requirements)......_. ` _ <br /> �yE ---- ------------- ----- <br /> Disposal Field (specify Requirements)__ ... -DD____ 8 <br /> ....... ..........# -------- - <br /> -------------------- <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 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 permit is issued, I shall not employ any person in such manner as <br /> to becam;j.sub' ct to Workman's Compensation laws of California." <br /> Signed._... - ._-.Owner <br /> By..---•--•. -- g jifT-- ..-..----=- -- Title.---- . ��'r/./�f IX ------ <br /> . T�J <br /> {If ether than owner! <br /> OR EPARTM T USE ONLY F <br /> APPLICATION ACCEPTED BY--------... i <br /> ?� ..... ... . . .... �­"`? - -- - DATE .... -7 <br /> DIVISION OF LAND NUMBER--------------- - -�-----_-- <br /> ....... <br /> --------------- .- ..._.DATE.ADDITIONAL COMMI:NTS-------------------------- - <br />----- ------ --- ----- ------ - -- - - --- ----------•-------------- --------------..._..._- - <br /> ------ ----- - <br /> -------•--------- ------- -------- - <br /> --------------- <br /> - - - --- ---- --- ---------- <br /> Final In <br /> by:.------ . - <br /> ---- Date.----- ...�� <br /> EH 13,24 ..... .......... <br /> y SAN JOAQUIN LOCAL HEALTH DISTRICTF3S 21677 REV. 7/76 3M <br />