Laserfiche WebLink
FOR OFFICE USE: <br /> This Permit Expires 1 Year From Date Issued <br />Garbage Grinder Lot Size <br />Private <br />Clay Loam <br />ZOD 'LEACHING LINE <br />XiSEEPAGE PIT <br />Date <br /> FOR DEPARTMENT USE ONLY <br />VV-ip-ig <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />.....Rock Size.. <br />Foundation... <br />.DATE <br />DATE <br /># ( <br />.PPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />.. ..Owner <br /> Title ... <br />Prop. Line..... <br />(If other than owner) <br />Sand <br /> Adobe-^] <br />NEW INSTALLATION: <br />PACKAGE TREATMENT <br />APPLICATION ACCEPTED BY. <br />DIVISION OF LAND NUMBER <br />ADDITIONAL COMMENTS . <br />(No septic tank <br />[ ] SEPTIC TANK <br />Capacity <br />Mo. CENSUS TRACT <br />.................. ............. .Phone ?XZ-.<?.7Z/ <br />... City..£^<^r^rA--^’*f Zip. <br />License <br />Commercial |)4 Trailer Court <br />—— IDepth...'2-'> ... <br />''Na'tet Table Depth.. <br />Distance to nearest: Well <br />REPAIR/ADDITION (Prev. Sanitation Permit#......... <br />Septic Tank (Specify Requirements).. <br />Disposal Field (Specify Requirements) . <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 County <br />Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br />signature certifies the following: <br />“I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br />to become subject to Workman's Compensation laws of California." <br />Signed <br />By <br />Silt Clay Peat Q Sandy Loam <br />Fill Material If yes, type ....... <br />JOB ADDRESS/LOCAT <br />Owner's Name <br />Address <br />Contractor's Name <br />Installation will serve: <br />□ate <br />F4S 21677 REV. 7/76 3K <br />Residence Apartment House <br />Motel Other <br />Number of living units:. ...... .Number of bedrooms <br />Water Supply: Public System and name <br />Character of soil to a depth of 3 feet: <br />Hardpan Q <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br />or seepage pit permitted if public sewer is available within 200 feet,) <br />Size. .3' )L.&....................................Liquid Depth,£..5^./... <br />Type... ^.... . Material.No. Compartments .......... <br />Distance to nearest: Well ......................Foundation.,.Z0 Prop. Line... J^.....'£? <br />No. of Lines ................Length of each line ... S'O... ......Total Length .. <br />'D' Box... LrZ Type Filter Material.. . Depth Filter Material /..S <br />Distance to nearest: Well.. ZlM'.t-. Foundation...Z.0.J.Z~7.Property Line <br />Diameter.. ..5^. ..Number 3^ ■.................. Rock Filled Yes®’ No ["/ <br />........... <br />.. C.^ . Z.Prop. Line rS <br />FOR OFFICE USE: <br />Permit No.Z^CtZ^^^ <br />Date Issued.///?.'-^5.”'?^ <br /> <br />Final Inspection by:. AX'**4*-* <br />EH 13 24 '— <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 Rules and Regulations: <br />■n /O/cz)