Laserfiche WebLink
a <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> •-------• Permit No. e* �W <br /> (Complete in Triplicate) <br />.......-•..............••-----------•-----•----•.... Date Issued ./Q..:L�...��' . <br /> -------.- This Permit Expires 1, Year From Date Issued <br /> _.... I <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LO ION � , CENSUS TRAC ............. <br /> S --Owner's Name P .1V :::.....:..... <br /> Phone ; <br /> AddressS.. 7 '-.C__t�. .©.r] 1. p.------ Cit r - ' .l ...................................= <br /> Contractor's Name U.j_f.f�..?. -... _.../ --------------------------------License # Phone <br /> Installation will serve: Residence Apartment House Commercial [JTrailer Court 0 <br /> Motel.)]Other ------- --------•••----- = -------- <br /> Number of living units ...... Number of bedrooms ...`./-....Garbage Grinder ............ Lot Size ....3_0................................ <br /> Water Supply: Public System and name .............................................. . .--...-..--•-----•........................ ......Private [gam <br /> a <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clays,❑ "Pegt❑ Sandy Loam ❑ Clay Loam ' <br /> Hardpan ❑ Adobe ❑ Fill-.Material ......... If yes, type ____________________________ <br /> Plot fan showing size of lot location of. system in relation'tb wells buildings etc. must be laced on reverse side.) <br /> { p g y 9 , p <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 204 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK X] Size_IC' .. _l?.....�................... Liquid Depth ..�t7..._...._....,..--- <br /> Capacity,r 4........... Type? -. Mater'ial'�I..410-_'`.�"_--_-•- No. Compartments ...$1............... <br /> t I'll 11 <br /> Sal V' <br /> Distance to nearest: Well 4'!�.................I.•..•....Foundation ._19......___.____ Prop. Line ...................... j <br /> LEACHING LINE ] No. of Lines �...° ................ Length of each line----- Total Length f D <br /> &� ...... Type Filter Material t... Depth Filter Material :�. �J <br /> Bax .- ----• ............................•----•- <br /> Distance to nearest: Well <br /> 5 � � ............. Foundation .../!?............... PropeLine' S <br /> Depth ..//-------- DI� !Y'Number. ----- ..................�— <br /> Rock Filled. Yeses' Na.[:] sa ; <br /> Water Table' Depth .....1. 0. <br /> ... Rock Size ., = <br /> Distance to <br /> Foundation __./p............ Prop. Line ..!{��:_._.:. <br /> nearest: Well .�tl.Q_'.•-----.•------------------- ..---. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...............................:------------ Date ---------------------------------- O <br /> Septic Tank (Specify Requirements) ....................-.......................................................................... <br /> - <br /> Disposol Field (Specify Requirements) -------------- --•--.....---............... ..........._._.._..--.._..----...------•------_-- -----~----- t <br /> ( I� <br /> --------------------------------------------------------------- --•----•-------•--...---•------------••-•...-----•---•--••.........---.........._.-_--- ................. -----• ----•---------- <br /> -..__.....-•...................................:.......... .............................................__.............-.._._-.._....... •---------------•--------------------------------------- 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 bone in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licew j <br /> sed agents signature certifies the allowing: <br /> "I certify th Tin th performanc of the ork'far which this permit is issued, I shall not employ any person In such.manner i <br /> as to be/comne su ' ct to Workm n ensalion laws of California." E <br /> Signe y(i'/ `r`��..,� <br /> -� .... . C.._..._..... .. --•.................................... Owner <br /> Y ..... ............................ <br /> (If other than owner) f <br /> FOR DEPARTMENT USE ONLY <br /> _ � l <br /> APPLICATION ACCEPTED BY DATE ................... l <br /> BUILDING PERMIT ISSUED ................................................................... ..._. .DATE <br /> ADDITIONAL COMMENTS ..........................................•--........---•--......-•-•--•--••--•---••. ------------_.:.:.••-•.............. <br /> .. <br /> ._. .. ...... <br /> -- - . <br /> Final Inspection by: ....:.................. ....-_.... :..... .............. Date ........./f ..�.2. r.....---•• i <br /> .. ..--••-• -----• -•-•••-•........... .......... ..._.. <br /> SAN JOAQUIN AOCAL HEALTH DISTRICT »` <br /> F 14 13 24 i.-AR Rn. sra 7/72314 <br />