Laserfiche WebLink
FOR OFFICE USESAPPLICATION FOR SANITATION PERMIT <br /> .................. Permit No. 2.7..:5.. <br /> {Complete low Triplicate) ' <br /> "� ..... This Permit Expires p Year From Date issued Date Issued .. <br /> .......-. .... .... ............ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constnid and Install the work herein <br /> described. This application Is made in eomplidnce with County Ordinance No. 519 and existing Rules and Regulations: <br /> I JOB ADDRESS/LOCATIO ..2x..... . ..�.'T ... .�`'_ CENSUS TRACT <br /> Owner's Name ..... fJ./L/� .......... ......................... ?la......................Phone ..................................... <br /> .address . ....... i t,r'O, ,44.16!.'! . ..... .... -----------------------.City .........................................-• •--------•-..... ......... <br /> Contractor's Name .. .... .... .. &.- #' .....•............L€cense Phone <br /> Installation wi_U serves Residence artment House Commercial OTraller Court <br /> Motel ❑Other..........................................I <br /> Number of living unite=---_../.. Number of ream ....Garbage index .. Lat Srize ..;� .. <br /> - f ._......... <br /> Water Supply, Public System and name ..��-! _.__ !---=-----------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand 0 Silt E3 Clay El Peat[] Sandy Loan❑ Clay Loam ❑ <br /> Hardpan❑ Adobe Fill Material .., if yes,type........................... <br /> 4Plot plan, showing size of lot, location of system in relation to,. wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit'permitted If public sewer is available within 200 feet) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ly SI e, ,5.:� ... liquid Depth <br /> yam ......... <br /> Capacity _ ___-- Type Material.. .4 o. Compartments °zJ----...--- <br /> Distance Ito nearest: Well .flf <br /> ..._ �,�-............Foundation,��..�....... Prep. line .�--------•--� <br /> =_EACHING LINE [�No. of Lines ---.../.............. Length Wfcch 1 ne....:'-:O . ."/ Total len h _.-- -0-Z........... <br /> � <br /> t `D' BoxX-ej Type Filter Matekial .Depth Filter Akar rlal ......e ....�.....................00 <br /> Distanc nearest: Well .e ...6. Foundat€on�d ... .... �Property line ��..l................. <br /> ^� X A _ _w <br /> SEEPAGE PIT [,,}� Depth ._. •--•-- Diameter .3- ---..... Num_ b_er .......... ... . Rock Filled Yet No ❑V' <br /> �` Water Table Depth _.:.. � .. .Rock Sime <br /> 10 f <br /> Distance to nearest: Well .._. ., � .r�...............Foundation .../.�- ... Prop. Line ........... ... <br /> REPAIR/ADDITION(Prey. Sanitation Permit# . ......... j/i . Date --------------------- ------•••1 <br /> Septic Tank [Specify Requirements) ...!„l0 f!`.r �. . ...... ./.�.:✓...F <br /> h ...... .........•.. .......... <br /> Disoosal Field (Specify Requirements) ,. '. .......... ..... .. : ..,� ..... <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 dose M accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regula}€ens of the San Joaquin Local Health-District:-Home owner or lion, <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is Issued, I shall net employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> <): ned ........... Owner <br /> - $Y ..title .. .. .. .� ,. .. <br /> (if other than owner) <br /> f FOR DEPARTMENT USE ONLY <br /> l ' <br /> APPLICATION ACCEPTED BY ... .- --- --- --:•..• -- ..... ...,. ............... DATE .. -. .... ...... .. .". <br /> BUILDING PERMIT ISSUED6. .. _.........:....:`........... ...-...-. .... DATE. ..................-----------. <br /> ADDITIONAL CQ]M—MEt�,t �............. ... <br /> .................................. <br /> t ---......`... ............................................ <br /> ................................ <br /> .2.............. ................ .... ..... <br /> Final Inspection by: -..... -� .. �. .....................................................Date .. .:..�r�-.:y7 ..........EH . <br /> 13 a 1"6 - SAN J AQUIN LOCAL HEALTH DISTRICT 8/7li 3M <br />