Laserfiche WebLink
Ute' FOR OFFICE <br /> I'll/ -- —0, APPLICATION FOR SANITATION PERMIT Perm <br /> ---1. ------------- ------- <br /> i&Tripl Rate) Vo. <br /> (Complete -ec <br /> Date <br /> Issued ------------ <br /> ---------- ------------- --------------- ThisPermitExpires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a)permit .to,.construct and install the'work herein <br /> fF-c <br /> described. This application is made iomplia—nce [th County Ordinance No. 549 and existing Rules and Regulations.- <br /> e <br /> JOB ADDRESS/LOCATIO -------- -----CENSUS TRACT -------------- ------_-- <br /> Owner's Name ------ zk ---------------------------------------- -------Phone ------------------I------------------- <br /> Address ----------------------- --- - ------ ---; City ------ --------------------------- -------"Z----------- <br /> *,?3 _ Ph , ------------------ <br /> ........License #/r, one <br /> Contractor's Name -------- -�-d_ _ <br /> Installation will serve.. Reiidence ��artment House,E] Commercial :E]Trailer Court �E] <br /> Motel F-1 Other ----------------------------------- <br /> Number of living units:----- Number of bedrooms <br /> ---------Garbage G:ri er ------------ Lot Size -_X1®_5------------- <br /> c <br /> 4 <br /> ---------------------------------------Private El <br /> Water Supply: Public System am name --- L <br /> - <br /> Character of soil to a depth of 3:feet': Sand'E] Silt 0 Clay F-1 Peat E] Sandy Loom [] -Clay Loam <br /> 'Hardpan E] Adobe U1__r1l, Material ----- ------ If yes,type ---------------------------- <br /> : <br /> (Plot <br /> ------ ---------------- <br /> (Plot plan, showing size of lot,'location of system in relation to wells, buildings, etc. must be placed on reverse sidel <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available withih 200 feet,) <br /> PACKAGE TREATMENT',, SEPTIC TANK! Size-----e <br /> ------------ -Liquid; Depth --------- -------------- <br /> UCCIPC!Clty Typj0e1_e,4?0n(�7M&erial No; :NCompartments ---------- ------ <br /> , — <br /> Distance' to7 nearest: Well -----:!�--_-_-----____ :Foundation .-/ -----------�Prop. Line ------------ <br /> LEACHING LINE No. of Lines --------./------------- Length of each line-/0-a----__-__.,--- Total Length 1A_`2--_-_--.---- 9 <br /> # �` <br /> A__C2----_------- <br /> f-----------------/......... <br /> D' Box Type Filter Material -----Depth FilterI Material <br /> Al. <br /> --- <br /> -------------- 5- ----- ------- <br /> (X� C Distance''to nearest; Well ----- Foundation Property Line -. <br /> SEEPAGE PIT Z ---- - ---------I---------- ------- Rock Filled Yes 10_�o I❑ JN <br /> EEP ------ Diameter M41--- Numbe, <br /> ------------Rock Size ---- -------- <br /> Water Table Depth ------ ac4----------------------- <br /> 6istance to nearest: Well ----------- ----------Foundation ----- O-r----- Prop. Line ........... <br /> kEPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> SepticTank (Specify R6quiremenTS) ----------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------- --------------------- <br /> Disposal Field (Specifi,,R_eqC�rements) ------------------------------------------------------------------------- -------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------- --------------------- ------- <br /> --------------------------------- <br /> -------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and requiredaddition on reverse side) <br /> . E <br /> I hereby certify that I haveprepared this applicatio;n and that the work will be done in accordance with Son 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 /> "I 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 Compensation laws of California-." <br /> --- <br /> .---- ------- ---------------------------------------Sign6j,----------------- - - - - 71:5ener- C ---------------- <br /> (if of <br /> owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .-- DATE,J <br /> ----------------------------------------------- - —----- <br /> ------ ------ <br /> BUILDINGPERMIT ISSUED --------------------- --------------------------r------------------------------ --------DATE _ --------------------------------------%-- <br /> ADDITIONALCOMMENTS ------------- ----- ----------------------- -------- ------------------------------------------------ ,--------------................F....... <br /> -----------------------------:------------------------------------------ <br /> ------------------------- ------------------------ f----------- -----------2�� <br /> ---------------------------------------------------------------------------- ---- -/---7/---- - - ------------------------------ --_��------------- <br /> ------ ----- --------------- ----------------- ---------------------k- --- --- -- -------- <br /> Date ------A - -------- <br /> Final Inspection by. --------------------- --------------------------------- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Ic <br /> E. H. 9 1-'68 Rev. 5M <br />