Laserfiche WebLink
65� <br /> C; 0 - '7/ <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> � <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------------------=-----------`� I-- - <br /> ------ Permit No.� <br /> I � (Complete in Triplicate) ���- --� <br />( Date Issued- <br /> ---------------- ---- -- ------ <br /> ssued---------------------------------` ___T ----------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local.Health Distr.ictifor,a per�mit�`tn const uct and install the work herein described. <br /> This application is made in compliance with County Ordinance No 549 arid existing'Ru1es and Regulations: <br /> - <br /> JOB ADDRESS/LOCATION_,_ __. !`v �'v _.. .�� f <br /> [' --- -- -- --- -- - --- ---- S ---- CENSUS TRACT <br /> Owner's Name ------ c.�-i� �p----- '-----� J ------------Y Q��-r------------ -----------------------------Phone; : 0 •`' ? --------- <br /> Address.----=----------- D - --- i j / ---------------------------------------City--- f?/_.J -:+r --------)".113-- -- - --------------- <br /> S �_ rte- [ <br /> Contractors Name--'-----'------;-�- /- ._._ <br /> Lice se # Phone _ _ <br /> p / n --- ---------- <br /> I �^ p fFIa C�r�. ( ❑ <br /> Other------ <br /> Number <br /> _ se. Commercial railer Co rt i <br /> ❑ 45 1t_e,G1 -------------- <br /> Installation will serve: Rest ence A ar m n ou <br /> Motel t - ,.-r•�-/—�-Y. ��(. p 1. r <br /> Number of living units:----1----------Nu iber.of bedrooms:.---k--Garbage Grindex__O�r�__Lot Size---!U_______ __-__l._/.--------------._ <br /> Water Supply: Public System and name--:----------------- '_.------ <br /> ------------- ` = E = Private <br /> Character of soil to a depth of 3 feet: i Sand 09---Silt 0 -Clay ❑ Peat ❑ Sandy Loam I] Clay Loam ] <br /> I Hardpan ❑ " Adobe❑ Fill Material_AQ_----If yes, type---------______- --_.------ <br /> _ r <br /> i (Plot plan, showing size of lot, location of system in relation to'wells, buildings,.etc must be placed on reverse side.) tF; <br /> NEW INSTALLATION: [No,septic tank or seepage pit permitted if'public sewer is avai[able within 200 feet,) <br /> ( 5 : <br /> PACKAGE TREATMENT SEPTIC;TANK ' Size------- !1� ~ - "_'___Liquid Doth..€__��_____________ _____ <br /> l Y ---No. Com � --"�+-.--� <br /> Capacity._1 _.=Type!"---.-��__f_---Material_ )__ Compartments -___ lam <br /> !Distance to nearest: Well.;_=_ f,7_Q_______`=____._.:____________Foundation <br /> LEACHING LINE [ ] No. of Lines_=,---_,,.2---- Length2 i'of each line.---- -'375_.-----Total Length.___.__1$40_ .___...______,___! <br /> D' Box..- _ . '__Type Filter Material zi_ o�`Dep-f Filter-Material-_ /.1---------------- -------- <br /> Distance to nearest: Well_____�.dd_--------------Foundation.____=_w_.n__±______----,.Property Line_ S^__-------------------- <br /> t <br /> i. SEEPAGE PIT [ ] Depth--------__ ----Diameter_:------i------;_ E❑ ❑ <br /> --Number------------------------------- Rock Filled Yes No <br /> Rock Size - ---; ---------------=----- ------ 4 <br /> D stanceWater atol nearest: Well Well ` -------- ----- - Foundation. Prop. Line. ------ ----- <br /> # -Date.----= -==-- r� <br /> -------=------ ... <br /> SepREOAcR/Tank <br /> ADDSpO�fy Requsements)n:Permit#--'-----=Y --- --------- -------------------- -i--=._:_..: ---------------------° --------------- <br /> Disposal <br /> - - ---... . <br /> -------- ------- <br /> Disposal Field(Specify.Requirements) _;,__ ------ - -- -- ---------------------------------- -------------- <br /> ------------------------:---------- <br /> ____ - -.________________________::__.___.. ..--._-----__-__--_-______-.---_-._---.-_--__—__.__________.__ of -_--_ --- <br /> s <br /> ----------------------------------- ---- ---- --- -----=--- ------------i-----=-------------------------------------------------------------------- ---------------- --------------------- --------- <br /> (Draw existing and required'addition on reverse side) s <br /> I hereby certify that I have prepared this application and that-the .work will be done in accordance with San Joaqui n County r1 <br /> Ordinances, State Laws, ��and Rules and Regulation' o he; San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the of dYnring: R <br /> "I certify that in a ormance of a work fo ich this permit is issued, 1 shall'not employ"any_person_in-rsuch-manner-as <br /> to become su t o Workman' ompensa ' awes rofr California:" '~ f <br /> Signed. '�------------------------ I = ------ :.---.-.--- ---Owner <br /> lBY --- ---------------`-- ---- ------- -- ---------- ------------------- - --- --------------- Title---------------- --- - --- --------------------------: -------------------- ) <br /> (If{ her thar 'owner) <br /> : FOR DEPARTMENT USE ONLY' }• <br /> APPLICATION ACCEPTED BY------- - -_ DATE ......----_l v�8-- --------- <br /> --------------------------------------------------DATE-------- <br /> ---------------------------------------DATE.------_ - ---- ----- -DIVISION OF LAND NUMBER- <br /> ADDITIONAL COMMENTS----------------------------------------------- ---- - ---=----------- = - --------------------=- ----=--------------'-------------- a <br /> -----------------­----- <br /> --------------------------- <br /> - - ------------°---• , <br /> F S <br /> ----- _________________________ ______________________________________ --_---.-_ - -_--------------_-_-----------------_ --. _ ---.___.____ ______________.___---_----. -_-------- <br /> ___________________________________________._ __ ____ --'----.--_-.-__ <br /> ____________ ----_----_-_._---__---_. ----- -------_ ---------------------- <br /> F <br /> __ <br /> -_ ----- <br /> Fna -inspection --------_ -Date_. �� � - <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 R 6 3M <br />