Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE. <br /> ' APPLICATIOK FOR SANITATION PERMIT <br /> J . - --_���f S.. J _ _ <br /> ir^ ° <br /> - _._f (Complete in Triplicate) Permit No. ---L <br /> -- -- _--- -- <br /> ----------------- <br /> _____________ This Permit Expires 1 Year From Date Issued Date Issued -_ --- _Z- -- <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 -00 Al - ---------------CENSUS TRACT --•-------•-- <br /> Owner's Name .-ANX--------�1 _SC0A1- ----- ----- -----------Phone <br /> s - - -Address ___4W___ <br /> a31 siarrl��,t <br /> - - ----------- City --5:�i2C�'.�/�---------------------------------•----------- <br /> Contractor's Name llr' ✓ --- r ----------License # 1,22$7373---- Phone ��{_� ___ <br /> ' Installation will serve: Residence JX Apartment House-b Commercial;❑Trailer Court [3 <br /> f Motel ❑Other -. <br /> Number of living units:.__/------- Number of bedrooms _2-------Garbage Grinder/1!__&__ Lot Size �/1, _ <br /> Water Supply: Public System and name - TM ,-.,._ ....- ._-._ <br /> - -- ----------- "... _--.".Private <br /> i Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 'E] <br /> Hardpan ❑ Adobe J2; 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 tank or seepage pit permitted if public sewer.is available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK,'Gd Size � �_� _. G/ ��_------ Liquid Depth __ �i <br /> k Capacityl—e"We , Type `C g Material 17I r No. Compartments �.____ <br /> Distance to nearest: Well rZ-5- -----______________•_---Foundation .../__a_`__________ Prop. Line ___ ----------- V <br /> LEACHING LINE + -No: of Lines _ ----------- Length of each line---/_4_�-`------------- Total Length -1 e-0./............. <br /> 'D' Box ,/V0--__ Type Filter ,Material , p --------------------------------- <br /> _ 041 -_--De th Filter Material -/ � <br /> Distance to nearest: Well _. _S --- Foundation __fes!____________ Property Line __,5�---_______________ <br /> SEEPAGE PIT Depth ... 5-_ p_-__ Dia _ l <br /> Diameter _ __Y____ Number __. ._ __rr-_ Rock Filled Yes No <br /> Water Table Depth 3F1--------------- ---------- --- -- - ---Rock Size <br /> Distance to nearest: Well ._ _ _e______________________Foundation _ -- ----------- Prop. Line ---F_r_.. <br /> .•----- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date <br /> Septic Tank (Specify Requirements) _______________________ <br /> ----------------------------------------------------- --------- <br /> Disposal Field (Specify Requirements) ------------------------------------ <br /> ---- <br /> --- - ---------------------------------------------- <br /> ------------- ------ <br /> --- - <br /> ------ --------- - --------------------------------------- ---------------------------------------------------------- <br /> 9 <br /> Draw existing and required addition on reverse side)- <br /> I hereby certify that 1 have prepared this application and that the work will be done ii-accordance with San Joaquin ` <br /> County Ordinances, State Laws, and.Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- t <br /> sed agents signature certifies the following: <br /> '1I certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such manner <br /> as to become subject Workma ' Compensation laws of California." ' <br /> i <br /> Signed ------------------ ------- - ------ Owner <br /> By ----------- ------- ` - -- ------ Title . <br /> ----------------------------------------------- <br /> ot t n owned <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ._,Lf <br /> F1.— --------------------- -- ---------------------------- ---_. DATE . ----�_ --7_. --------- ------ <br /> - - <br /> BUILDING PERMIT ISSUED - ----------------------------DATE ------- <br /> ADDITIONAL COMMENTS <br /> --------------------- ----------- t <br /> --- <br /> ------------------------------------ ---- - <br /> Final i ------------------------------------- -------------------- <br /> --------------- <br /> '] <br /> - ----- ---- ---- --- �t-----------------------------Date --- 7w . <br /> SAN JOAQUIN -LOCAL HEALTH ;DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br /> _ a <br />