Laserfiche WebLink
l & FOR OFFICE USE: «a - '� Y <br /> APPLICATION FOR 'SANITATION PERMIT r <br /> ---------------------------------------' Permit <br /> = <br /> --------- -- ------- -- `. <br /> (Complete in Triplicate} s <br /> his Permit Expires 1 Year From Dote Issued Date Issued __ :7. <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/LOCATION -- -- �.C� _ �1-t--- c—��c� - _� __ 2_..----CENSUS TitACT -------------------------- <br /> wner's Name <br /> O --- --P one - 4��0 7y.-? <br /> �f gg <br /> Address ........... <br /> ----- - -- - �-V-- -- - -- --. - - ------- ---------------City -- --- ---- -------------- ----- --------------------------------• <br /> Contractor's Name _.___------. License #oG�x � - - --_ Phone <br /> Installation will serve: Residence Apartment House,0 Commercial ❑Trciiler Court i❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units:----/-- Number of bed oms ______Garbage Grinder _7707._ Lot Size ----Sb��a( �Q/ <br /> Water Supply: Public System and name ---_---, '� -------� --------------------------------------- Private ❑ <br /> -------------- <br /> Character of soil to'a depth of 3 feet: Sand'o Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> r ' Hardpan ❑ Adobe X' Fill Material ------------ If yes, type ------_--------------------- <br /> (Plot <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 pit permitted if public sewer is'available within 200 feet,) ! <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] 1.S�`/ e------------------------------------------------- Liquid Depth -------------------------- O <br /> Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ---._...------------ � <br /> Distance to nearest. Well ---------__-�f-----------------------Foundation ---------------------- Prop. Line ---------------,------ <br /> LEACHING LINE �]' No.rof. Lines _______ ______'___:__-__ Length of each l' ------------- Total Total Length - _- _____...._.:..__ <br /> D Box 1.._/.____.__ Type Filter Material _ f�_ _ _ _-___Depth Filter Material -___,l fes__ ____________________ <br /> ye`n - - i � l <br /> �*° Foundation ------ --' ...•�w <br /> Distance to nearest:,�Well�if��_.__ �___ _________ Property Li e-��____-_�.... <br /> SEEPAGE PIT ' Depth,' Diameter Number -------/---------------- Rock FTed Yes c <br /> Water Table Depth ----------_. -------------------=--------Rock Size v�---r�------------- <br /> Distance to nearest: Well ___ ___.,____Foundation ----Z4--- -_-- Prop. Line ----- __ _____ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ________ -------- -------------------------- Date ____________________________._..-_} <br /> t <br /> Septic Tank (Specify Requirements) ---- --------------------------------- f-------------- ---------- --------------- ---------------------- <br /> Disposal Field (Specify Requirements) ------ . -- ___________. - -------- ------- ----- -- - - ------- <br /> L.; <br /> -----_ c ,5"------ <br /> ------------------------------------�'"- -�1 - ------ ------ <br /> ---------- -•--------------------- ---------------- -------------------------------- ------------------------------------------------------------------------------------------------------- <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 Son .Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Rome owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this'permit is issued, I shall nof employ any person in such manner <br /> as to become subiect to Workman's Compensation laws of California." <br /> Signed --------------------------- ---------------- --------------------------------- ---- Owner <br /> By ------ ---------- --------- .Title ______ <br /> (If other than owner) <br /> O FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- -------------- --- - --------------------------------------------------. DATE ' ` �•-„----------------- - <br /> BUILDINGPERMIT.ISSUED - -------- ----------------------------------------------------------------------=---- -------DATE _..----------------------------------------- <br /> ADDITIONALCOMMENTS ----------------------------------------------------------------------------------- -------------------------- --------------•------------------ <br /> o ; <br /> S ' -- ------- -- ------- - -------------- ------ _ <br /> - --------------------------- ------------------------------------------------------------------------ --- <br /> FinalInspection by: ----- ---- - ------- ----- - - - ------------- -----------------------------------------------------Date ---- -= <br /> f AQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />