Laserfiche WebLink
;,FOR OFFICE USE: 1"z6oiRPLICATIO-OR SANITATION PERMIT ' <br /> ---------------------------------------- r <br /> (Com Permit o. <br /> ------ ----------- ----------------------------------- '7A 7 U <br /> This Permit Expires 1 Year From Date Issued Date Issued ---_ ______________ <br /> 2cf7 <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 '!-___ , --- <br /> E Qr GG1��CCYq��`r CENSUS TRACT <br /> Owner's Name ---- -------------- ------------------------------•---------------------------- ------.Phone ---`s �.06 --........--- <br /> lob C <br /> Address --------------d��j--- - --- 3o1.3C3 _ City �1.Ot -------------------- <br /> Contractor's Name -Kp3 � 2t�5. 1t�t � - License # Phone <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court i❑ <br /> Motele0ther <br /> Number of living units:------------ Number of bedrooms ------------Garbage Grinder -.---------- Lot Size ________--_____________________________ <br /> Water Supply: Public System and name -----------•--------------•------• -- -----------------------•----------------------------------------- ,---Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'E] Silt fl Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam] W <br /> Hardpan ❑ Adobe '❑ 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-460 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK?[ ] Size------------------------------------------------- Liquid Depth --------_____________,_____ <br /> t <br /> Capacity ------ - ----------- Type -------------------- Material---------------------- No:--Compartments ------------_-------- <br /> �-��N <br /> Distance to nearest:. Well ___________________________________Foundation _ -------------------- Prop. Line ---------------___.__ <br /> LEACHING LINE [ ] No. of Lines ---__------------------- Length of each line --------------- Total Length -----------------_-------- <br /> 'D' <br /> ____-___•__-__...__-_. _'D' Box ------------ Type Filter Material ____________________Depth Filter Material _.___._________________-•_-.•-_----_--__._ <br /> Distance to nearest: Well ________________________ Foundation ------------------------ Property Line. ________.____-____-_-•__ <br /> SEEPAGE PIT [ ] Depth ----------- Diameter _______________ Number ____________________________ Rock Filled Yes ❑ No'o <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) - -----U1,3s; i------------ ------------------------------------------ <br /> Disposal Field (Specify Requirements) ---��-----\DQr--c):r---��IasGl ----, @,.-- <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 San 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 /> Sign Owner I <br /> B ------- ----- Title ------------------- <br /> ---------------------------------------------------- <br /> ----------------------------------- <br /> (If oth r than owner) <br /> FOR .DEPARTMENT USE ONLY <br /> �} <br /> APPLICATION ACCEPTED BY --- ---- - ----- -------------------------------------- ------------------------------------ DATE --- _ - - <br /> _ <br /> BUILDING PERMIT ISSUED --- -- ---------__ -------DATE --------------------------------- <br /> ---------- <br /> ADDITIONAL COMMENTS ------ -- ------------------------------------------------------------------ <br /> ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -----------------------------------------------------------------------------7----------------------------------------------------------------------------------------'--------`------- ----- <br /> --------------------------------- <br /> ------------------------------------- -- --- ------- <br /> ---- <br /> Final Inspection by: - Date 9_------------------------------------ <br /> SAN <br /> ______ ___________________________SAN <br /> JOAQUIN LOCAL. HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />