Laserfiche WebLink
X p��Q��� / ��• FOR OFFICE USE: 4 <br /> � FOti OFFICE U5E: i APPLICATION FOR SANITATION PERMIT o <br /> 7 � <br /> Permit No--- -------- ----- <br /> I`--""" <br /> (Complete in Triplicate) <br /> -------- ---------- --------------- I <br /> `` -- Date Issued_5.- C>3_ - <br /> _---- - <br /> S' <br /> ----------------------------------------I <br /> This Permit Expires 1 Year From Date Issued <br /> in Local <br /> Application is hereby made ItIiSon JoaquCountyOrdinonce sNo. 549 and sting Rules work herein described_ <br /> es and Regulations: <br /> This application is made in com p d ----;_ <br /> TRACT---------------------- ----- <br /> JOB ADDRESS/LOCATION CENSJp ---� � <br /> onePh _ T <br /> ---� ------- -------- ----- - - - <br /> -- ' <br /> 1 <br /> 1 Owner's <br /> ®Cl <br /> 1 <br /> c _ dnet <br /> �-- - ------- -t---�-• -- - - _ <br /> Address ... .., _ --------------- <br /> F <br /> [,/� _ • <br /> License <br /> = - ------ - ¢7` <br /> ' ------- -A <br /> Contractor's Name- P <br /> h '- <br /> - a <br /> Installation will serve: sidence (Apartment House.❑ Commercial ❑ Trailer Court [I <br /> ❑ r ------ - i _ <br /> , Motel -='- - �_ -- ---. --- --- ----= --- - ------- ----- <br /> Othe - <br /> I <br /> Number of living units: "" . _Nurriber of bedrooms . --------Garbage Cnndea•-._' - -Lot,Size. "_". <br /> t i N , t... i.. ---PriVatB � <br /> Water Supply: Public Syste IM and name_ .: El Character of soil to a depthl�of 3 feet d ❑ Sil .❑ Clay E Poat❑ _ Sandy Loam ❑ Clay Loam <br /> t "' Adobe FiII Material.-_ --'----_.if ye"s,type-------------- ----- <br /> Hardpan ❑ ` i <br /> {Plotpla showing size of.16t, location of,system in relation torwells�buildirlgs,.etc.^must be placed on reverse side.) <br /> s... <br /> NEW INSTALLATION: (N;b se tic' tank�`or see_ t permitted if "publ'ic sewer is ava'slable within 200 feet,) <br /> a�� p _ � r•--r� ----------Liquid Depth., - -'---- <br /> } Material._ --- . <br /> PACKAGE TREATMENT I -]5h ISEPTIC'�TANK"14 Size- --------------- --------------- <br /> Y-4 ' i N partments-----�--------------- <br /> CapacitY� a------ r <br /> o dam - <br /> �', ! ! <br /> ]Distance to nearest•. Well- /��__�, ~-- " __Foundation.lc7. '.-----•• -----Pro . Line- -----------------[� <br /> tr i r -------------- <br /> ' = ' ` Length of. line.,, --------.Total Length. -_ <br /> I � <br /> LEACHING-LINE [ ],. _N&—of Lines •- - . ,- <br /> -- <br /> D Bax_J� �Type Filter MateriaL_� Depth Fitter Material__ ------------------------------ , <br /> s:� n M _ p ------------------ <br /> ----------------- <br /> toDistanc� i earest: WeIL_.___-_;__- -_ � Foundation-.-__-- <br /> - - •- = ' Property Linei <br /> ' .,-. _ :• r , Rock Filled Yes 0 No7q <br /> SEEPAGE PIT t I l De th- = -'___ Diameter-'--------- -Nu ber ---------------• _ <br /> p. <br /> l -table <br /> le► --------------------------- ------------ <br /> _ . . Water Table.Depth---= --- -- �--- -----------., -- Ze----------------------------------- <br /> •__ Rock . i <br /> i� i rProp ine------- - -- <br /> Distance.to nearest: Well. :__. Foundation------------------- <br /> REPAIR/ADDITION (Prev. Sanitation►Permit#____. __. -••--- <br /> Date. <br /> -+ iM --- - ---- ---- -- <br /> ' I� - <br /> I? p y. q = = <br /> Se tic Tank,(S ecif Re ui:rements]-------- • ----==- - -------- --°- ----=�-�--°,--- ------ . -- ---I-- <br /> Disposal Field (Specify Re.quire.ments)-------: - -----=-- -=---- ------------------------------------------- <br /> i <br /> --- ------------------------------------ <br /> ---- <br /> i --- :-= -- .: ----------- - ---- _ , <br /> -------------------------- - <br /> ---- ----- <br /> -------- <br /> `- - -- - ' = = -------------------------------------- ----------------------------- -------- <br /> - - <br /> # 9 " (Draw existing and required'addition.on reverse side) . <br /> I h reby certify that'l ha' -prepared -this application and that the work will be done in accordance with San Joaquin Count] <br /> Orairtances,l State Laws;t�and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licensed agenti <br /> signature certifies the following: <br /> ¢ <br /> "I t icertify thatin-the performance of the work for which this permit is issued, I shall not employ any person in such manner la <br /> ? to become subject. to Workm n-s Compens dtio+i''laws of California.". . <br /> /JOwner <br /> Y <br /> Signed_ ' <br /> . ,.. �- <br /> l - <br /> - - ---- --------- - Title <br /> (If other than owner) <br /> FOR DEPARTMENT USE'ONLY <br /> . r. <br /> _ - ------ -DATE ._� — -_ ---- ------- <br /> APPLICATION ACCEPTED BY_. '�" " <br /> ------ --- " ---- <br /> ---------------- <br /> --- <br /> -- -----:---DATE-- ---------- ---=------ -------- -----`- <br /> DIVISIONOF LAND NUMBER------- ------ - --=--- -------------------------------------- ------------- ----- -- <br /> ADDITIONALCOMMENTS------------ ---------------------- ---------------------------------------- ----------------------------- - <br /> f ----------------------------------------------- ------------------ - <br /> ---------'----- ------------------ -- ------------- 9 <br /> --- ---- --------- -- -------------------------------- <br /> ------------- ------- --------------- <br /> __ <br /> ---- - -------- <br /> ---------- ---------i �- _ <br /> - - -- ----Date_._ ------- ---- -- <br /> Final Ins ection b <br /> --------- --------- <br /> -------------- - ---- <br /> p y. ---• - - -- FES 21677 REV. 7/76; <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br />