Laserfiche WebLink
;x <br /> FOR OFFICE USE: �� - FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> F �yq <br /> Permit No... ..�....... .. <br /> (Complete In Triplicate) I <br /> a. ........... .. . ..._ .- . _ ........ ..... .. <br /> �-to <br /> Issued.. .....��-.... <br /> "r <br /> ............................ • .....•.. .- This Permi•_'r:oires 1 Year From Dote Issuod <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> +. This application is made in compliance with County Ordinance No. 549 and existing R::les and Regulations: <br /> JOB ADDRESS/LOC< lom, <br /> 1.p ij 7... �j'.���.'�� .............CENSUS TRACT ........................ - <br /> Owner's Name � f - . . ...... Phone . ..... <br /> Address..........- . �'►'L�i.. .. .. ..... City..... ..... .... . Zip.............................. <br /> 'T Contractor's Nome.... License #.-3.a.. ! Phone.. �. /.Q � •-• <br /> [ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ 0t1:er._. <br /> i Number of living units:.... .. .......Number of bedrooms.. Gu�ba a Grinder Size....... .. �' rt.�........ <br /> ... .. ...._ ..... ........._........Private <br /> s �S <br /> F `Voter Supply: Public System and name.. .. . ..................�...... ... . . .9. . . ........... ................ .. <br /> ' Character of so l to a depth of 3 feet: Sand❑ Silt❑ Clay❑ Ptat❑ Sandy loom❑ Clay Loam <br /> -{ <br /> Hardpan❑ Adobe❑ Fill Material . .. .If yes,type................. . .. . <br /> (Plot 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 pi' pormittod if public sewer is available within 200 feed <br /> PACKAGE TREATMENT [ J SEPTIC TANK [ 1 Size .�� X �r. T /4-••••••• •.•.. •• .-.Liquid Depth.. #...............3,;�J <br /> Copocity/.4rl-.O.0...Type.... -Material..... .......No. Compartments-A....... .......... ... <br /> yq <br /> Well.......... FoundationProp. Line............................Distance to nearest: ; <br /> I. LEACHING LINE [ j No. of Lines . ✓..................Length of eoch line......` .IV......... ...Total Ll?ength/p�-p.......................f.-{ <br /> : 'D' Box Tyoe Filter Material. . . pth Filter Material.. ...�l....,...... ............. .................... <br /> j "Foundation.--•................ . ..Property Line.................................. <br /> ., Distance to nearest:Well................ . P Y <br /> SEEPAGE PIT Depth.. �. yZ <br /> 1 [ ) ~.Diameter.... . '....Number. ..��� Rock Filled Yes No <br /> U <br /> s" Wator Table Depth............................. . _. .....................Rock Size.. . <br /> .................... <br /> r <br /> Distance to nearest: Well....�....la�.�....... .............Foundation............. Prop. Line.........................: <br /> x t <br /> REPAIR/ADDITION (Prev. Sar itaticn Permit#.................... .. ..... .... ... ...........Date.................................. . .........) <br /> Septic Tank (Specify Require:-tents). .. . .. ........... . ..................... .. ... ............................................... ' <br /> .................. .... . ... ......................... <br /> M •�9 <br /> : ..... ............ ._........................................... ................................................ <br /> Disposal Field (Specify Requ rements) ..... ........................ .. .. <br /> ........ ........... <br /> .. ..... .... . . ................................ ............... ................................ <br /> ....... .................................................. ...................................... ... . <br /> t <br /> 9 County <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 Coun . <br /> Ordinances, State Laws, c:nd Ruses and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: z'a <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as <br /> to become subject to Workman's Compensation Vlawsefalifornia. ' <br /> Sinned......... - .........OwnerBy.................7'1.7/3.i,.".,;.V. _... -.. . ... Title............ ....... .............. ........-.............. <br /> . ............. <br /> If other t an owner) <br /> R EPART ENT USE OIJLY <br /> -- — <br /> �. .. ............. ......... .......DATE .......°I <br /> APPLICATIOt ACCEPTED BY.......... . . . ;.!i�- <br /> x. DIVISION OF LAND NUMBER... .. . ..... fid.._ .V ........................ ............ DATE............................. . .... .......... <br /> ADDITIONAL COII�MEN75 . ............ .. . _�/ �(.C�.tie./ ..��•G�...��{.. �,t �r ...� ...... .. ........ t!lsr ` <br /> r ,7" tl <br /> - S <br /> _............... . _ ......... ...................................................................................... <br /> w L' � _ .. ..........� <br /> ............................. ...... ........... _..... ... <br /> .. .... .. . ....... .. <br /> Fina! inspection by: ......_..� .. Date. .. ....... /�'.. .--•• +` <br /> EH 13 44 / SANAQUIN LOCAL HEALTH DISTRICT US 41677 REV.7/76 1M <br /> �� � ,.Kn» a.•..-.rec�uti aha'�<lstai�.�•,::+.'.E�:i;.:37+t►:�:'�€i'iigtke',p®"$a�'R�.;'"M '�:ir;�'..L av,�•,�+fi�.a's.r�:A1r�aEri.,� ;"" r�,r,�, �� - <br /> ;w <br />