Laserfiche WebLink
FOR OFFICE USE: � FOR OFFICE USE: <br /> i APPLICATION FOR SANITATION PERMIT = <br /> ... `""+ Permit No. , <br /> `I\ � [Complete in Triplicate) <br /> 'i -------- -- <br /> i et^ Date Issued_.=,/_71 <br /> ------------------------------------------------------ This Permit Expires 1 Year From Date Issued <br /> r <br /> Appliction 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 Ordi once No. 549 and existing Rules and Regulations: <br /> t <br /> JOB.ADDRESS/LOC ION._, , - <br /> ' !__CENSUS TRACT <br /> Owner's Name------ -------- - r - ------.Phone --0.- -.- I <br /> Address ---------------/ 7 - - :City Zip r .. <br /> Contractor's Name_.`.___._:-- - -.. ----------------- -License # .-- .j_--Phone---------------p_ � 7__. <br /> Installation will serve: Residence K A. rtrp9t House❑ Commercial ❑ Trailer Court ❑ <br /> t � ' II � Motel E Other----------------------- --- ---- -------------- 'F <br /> Number of living.units:......[-^.._____Number of.bedrooms_.. __Garbage Grinder.--------- Lot,.Size-_____________ ----------------------------------------__-----. <br /> WciteriSupply: Public System and name 1-1 ------------- ----------------------------------------------------------- <br /> ------ ---� �----- - _--- ---t. ---------------------------------------------------. -Private�❑ <br /> X <br /> dnd,D <br /> � % �: yes, type --: _❑ Clay Loam ❑ <br /> Character of soil to a di� Q dpa'n,❑ Adobe] SIFiI�Material " Relft es Send Loam <br /> I„ .SCC Y Y <br /> (Plot p.11an, showing size of;'lot;-location of.sastem in relation to'wells, buildings, etc. must be placed on reverse side.) �. <br /> NEW INSTALLATION: "(No e tic tank .or-see a e � it per if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT �, SEPTIC TANK' '[f]- Size'_----____--' t <br /> P � P_g P� P <br /> S - <br /> [. ) k }. --------------------------------- Liquid Depth.-- t^). <br /> { P Y .� yPe-------- -, -------__:---._-= o��Compartments ' _ <br /> i D scan a .to neares# Welt.e Material mandation - ---Prop. Line--------------<: <br /> LEACHING LINE. [ 1\ No. of Linesl-_=-- ..... _ :Length.of each line._ Total, Length ____ ,-_---___ -_. : _ <br /> Box._t ___,Type tilter--Mater-ial;T.,,_ --__-Depth-Filter Material.-:--- I __ --------------------------- ----------- <br /> pistanc 'to newest:WM.- -Foun-d-ation�-- -_ ._-Property Line_ . _ <br /> SEEPAGE PIT [ ] Depth-_.. I :__ Diarxleter �._�_ N.u-mber =__-- _ Rock Filled Yes.❑ No EJ <br /> Water Table Depth -- ---------- --------------------------i.Rock Size _ <br /> . e ------------------------------ <br /> Al <br /> . ' .......+-P <br /> 'p. ]Line..____ -___ <br /> tDistanceao a rest: Nell:' _ F o <br /> ._..-_----_. <br /> REPAIR/ADDITION (Prey. <br /> .Sanitation,Permt #e - ______________ __ <br /> Septic]Tank (Specify Requrerrlents)_..l I > � P ---- --- --------------------------- <br /> ----- ---- -------------------- <br /> Field <br /> - ---------------- <br /> I <br /> I i / , <br /> Disposal Field(Specify Requirements)_........ <br /> A-' "tri:✓ ___ __ ; <br /> - ------------------- --- <br /> -----------,---------------------------- X ------ ----------------------------------------- <br /> ------------ --------------------------- ----------------­- ------------------------ ------------- -------------- -------------------------------------- -------------=--- <br /> -------- ---- ----- -- <br /> (prow existing and required addition�on reverse side) <br /> 1hereby certify that i have prepared this application•and-that-the-work--•willtbe done in accordance with San Joaquin County <br /> Ordingnces, State Laws,t andg Rules and Reg, ulations ofY the San Joaquin Local Health District. Home owner or licensed agents 1 <br /> signature certifies the followin <br /> "I certify that'in the performcihce of the work for which thi's permit is' issued,.1 shall not employ any person in such manner as <br /> to become, subject Jo Workman's Compensation laws of California.'.' <br /> Sign=E edw .: --------- <br /> . . - 7' <br /> �-:-%- -�. .?J „-----Own_er <br /> BY]- ---------------------------- <br /> (If <br /> ----- ------(If other'than WxineF <br /> FOR DEPARTMENT USE ONLY 1 <br /> APPLICATION ACCEPTED BY- - ----------------- ------------------ ----------: .DATE.-.-mac- / ------------------ <br /> DIVISION OF LAND.NUMBER------------- ------------- ------------ -------------- ------------ ----------- ------------ DATE----------------•------------:- --.- <br /> ADDITIONAL COMMENTS. - = ------------------------- <br /> 9 <br /> ! {�� <br /> 1"' °r. Wv--------------------------- -------------------------------- ----------- ------------------------ <br /> -- -- -- ----- <br /> ------------ <br /> ---------------------------------------------------------------------------------------------- <br /> - ---- ------------ <br /> Final kInspection by ----- ---------- ==_-=---------- ------------ -----_- -------------------------------------Date ------ --------•---------=' = <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 21677 REV, 7/76 3M <br />