Laserfiche WebLink
N <br /> OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No- -------- <br /> (Complete in Triplicate) <br /> ----------- Lx- -------------------- i;- " I I Datefisued _4-2::-z�::-6 <br /> A ___ This Permit Expires I Year From Date Issued <br /> ------------- ---------------J — <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and insA"11 he work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules' U and Regulations: <br /> JOB'.'�ADDRESS/LOCATION ------ -------------CENSUS TRACT ----- --------- ----------- <br /> 6 S7. ------------------ -------------------Phone ------------------------------------ <br /> Owner's Name - -------evX, -- --------- ---------------- <br /> Address ..... kv e.-----------------------------------------------------------------------_-, city ------------------------------------------------- <br /> Contractor's Name ---------------------------------------License #14W- Phone�_�_ <br /> Installation will serve: Residence Apartment House-E] Commercial'E]Traller Court !E] <br /> Other --------------------------------------------- <br /> Numb'e'r of living units:'---I----- Number of bedrooms .-_1-'--Garbage Grinder Lot Size APO -------- <br /> Water Supply: Public System and name <br /> 1X_A/ __'_________________________________Private <br /> Aroo�� E] <br /> Character of soil to a depth of 3 feet. Sand[] Silt❑ Clay E] Peat F1 Sandy Loam E] Clay Locim,E] <br /> Hardpan E] Adobe -04 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 funk or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK'[ Size------------------------------------------------ Liquid Depth -------------------------- ' <br /> Capacity <br /> --------------- -------- <br /> Capacity --------------------- Type -------------------- Material---------------------- No. Compartments ---------- -------L---- <br /> 0----------------------------------- <br /> Distance to nearest: Well Foundation ----_:------_---------.Prop. Line --------- <br /> ------------- <br /> LEACHING LINE No. of Lines -------- --------------- Length of each line---------------------------- Total Length ---------------------------- <br /> 'D'-,Box ---- ------- Type Filter Material --------------------Depth Filter Material ---- --------------I-------------------- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line. --------- -------- <br /> SEEPAGE PIT Depth -------------------- Diameter ---------------- Number -------- ------------------- Rock Filled Yes ❑ NoO <br /> Water Table Depth --------------------------------------- --------Rock Size -------------------------------- <br /> Distance to nearest. Well ----------------------------------------Foundation —---------------- Prop. Line -_-------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- <br /> Septic Tank (Specify Requirements) -------- ------ - ----------- <br /> - ---------------/­----------------- --------------- <br /> Disposal Field (Specify Requirements) ------e- ��_V--------- ----------- <br /> ------------------------------------------------------------------------------------------------------------------------------------- <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 San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> certify that in the performance of the work for which this permit is,issued, I shall not employ any person in such manner <br /> as,to become subject to Workman's CompAnsation laws of California." <br /> Signed ----------------- ---------- -- ------------------------------------._ Owner <br /> By - ---------------- ------------------------------- Title ---- -- -- ---- -- - ------ --------------------------------- <br /> r than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------- ------------------------------------------------------------ <br /> -- DATE ---- ------------ <br /> BUILDING PERMIT ISSUED --- /,jr -OX------- DA-T I------------------------------------------- <br /> ADDITIONAL COMM -- ---- -----------------------------O-P-------------------------------------------- <br /> ENTS - 4 <br /> --------------------------------------------------------------------------- --------------------------------------------------------------------------------------- <br /> ----------------------------------------- - ----- <br /> ---------------------------------------- --------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------- - <br /> Final Inspection by: .......... -------------------------Date -------- ------P <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ti <br /> E. H. 9 1-'68 Rev. 5M Al <br />