Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> --------1I'-�0-- Permit No. Z_Z_- �-�P--- <br /> (Complete in Triplicate) <br /> ---------------------------------------------- <br /> --------------------------------------------------------- This Permit Expires I Year From Date Issued 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 /> described. This application is ma ! o� nce with ounty Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOC ATIO <br /> - ----- ------- -�------- ---------------------------, ---=..---- ----------------CENSUS TRACT ---------------------_-- <br /> __ <br /> --------------------••-- <br /> Owner's Name ______ _ ______ -- - ---- - <br /> "fir '.". ='.----------- ---Phone ------------------------------------ <br /> --- <br /> Address - --------/— ----------- d ale-- --------- City -- --------------------------- --- <br /> -�- r.0 _ #�c1 'r Phone -���'Fel 4- <br /> Confiractor's Name ___________ _ _ _._ _ _______.License <br /> Installation will serve: Residence ``Apartment House E] Commercial:❑Trailer Court ',❑ , <br /> Motel ❑ Other --------5-:;-------------------------------- <br /> Number of living units:-- _/---- Number of bedr ms -__,j'_-_.Garbage Grinder / Lot Size -----�------��-C�-!-- --------- <br /> Water Supply: Public System and name ---------"---lL ------_ -------------------------------••------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe p` 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 { ] SEPTIC TANK' -Size---a--_X __. p------- Liquid Depth ____6_ ---------------- <br /> Capacity��pGtRx�Type Material- - --f' No. Compartments ------------=-•-- v <br /> Distance to nearest. Well ---t'i--—__________________Foundation .../c, _____ --- Prop. Line <br /> LEACHING LINE No. of Lines -_ ----------------- Length of each -line_-__6ksg <br /> - ---�----.____-- Total Length <br /> 'D' Box __ -__-_- Type Filter Material Av -------Depth,,Filter, Material ...437- ----------_________________ <br /> Distance to nearest: Well t$ _q!_,---------:-_- Foundation G_f__.__.!-----' Property Line --- ------------- <br /> SEEPAGE PIT Depth __________ ________ Diameter ______________- Number ----------------------------- Rack Filled Yes [ No (3 t <br /> WaterTable Depth -------- ---------------------------- ----------Rock Size ---------- ----------------- <br /> Distance to nearest: Well ________________________________________Foundation ------I--------z---- Prop. Line :____-.-________...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -----------------------------------------•--•Date ---------------•---t-------.--.----) <br /> Septic Tank (Specify Requirements) - ---------------------------- <br /> -------------- ---. <br /> DisposalField (Specify Requirements) ----------- -------------------------------------------------------------------------------------- -----------`--------------------- <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 San JoaquinAocal Health District.'Home owner or liven- J <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 /> Signed -------- --- --- -------------------- --------- ------------------ Owner <br /> J <br /> 4 <br />' BY --------------------- --- - - - - - ---- -=------------- Title ---- --- ---------------------------- <br /> (if <br /> --------- ----------- - <br /> (if other than owner) <br /> R DEPARTMENT USE ONLY 1 . <br /> APPLICATION ACCEPTED BY ----- - <br /> - -- - - - .----- --------------------- ------------------------ --------------- - DATE --h/.-1J---- --�--------- <br /> BUILDINGPERMIT ISSUED ------- - --- -- -- - - ------- ------------=----------------------------------------------------`.---DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS ------ - -- ------------ -- - -----------------------------------------------------------------' <br /> ---------------------------- - - <br /> ---------=--------------------------J-- ---- -'- ----- -------------- --------------------------------------------------------- ----------------------- ------------------=------- <br /> FinalInspection by: ------ - - - - ---- --------------------------------------•------ ---------------------------------Date - _ -- <br /> r' AN JOAQUIN LOCAL HEALTH-'DISTRICT . - <br /> 4 <br /> E. H. 9 1-'68 R V. 5M <br />