Laserfiche WebLink
FOR OFFICE USE: 3 <br /> l f_ APPLICATION FOR SANITATION PERMIT <br /> %- a <br /> r -7 <br /> Permit No_ <br /> (Complete in Triplicate) I <br /> 11 <br /> ---------------------_-------------------_--------_------- This Permit Expires 1 Year From Date Issued <br /> Date Issued __ _ Q <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/LOCATI . -- _ � ------ - _-._--------------CENSUS TRACT <br /> I --- __.•. <br /> Owner's Name - ----------- - ----------------- -Phone --� � <br /> Address ---------- ------- 7-------------- ----------- -� �--- - ---. City --- <br /> p <br /> Contractor's Name t -- --------- -----------'=------_license # � �/------ Phone _ 4 .:1� . <br /> Installation will serve: Residence LPV­ <br /> NyApartment House-E] Commercial :❑Trailer Court ,❑ <br /> i <br /> Motel ❑Other . <br /> Number of living units:_--{ ----- Number of bedrooms _____7>"-Garbage Grinder ------------ Lot Size _.__,�A/119�1._Z�9" <br /> Water Supply: Public System and name -------------------------------------------------------------- ---- ---�N-Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom .El <br /> Hardpan ❑ Adobe)e Fill Material ___________ If yes, type --------------------1�I_______ <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 [ ] I'Size -2 ___ Liquid Deptli�________.___------------- <br /> i� <br /> Capacity -------------------- Type t i = __ Material,-' No. Compartments = <br /> Distance to nearest: Well --- --- x---f--------------Foundation ----------- ------ Prop. Line ----_----------------- <br /> LEACHiNG LINE [ ] No. of Lines ------------------------ Legh of.,each line--------------------------. Total Length !�--------------------------- <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 �es ❑ No <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- � <br /> —Distance to.nearest:Well, _----------------------------------Foundation ------_-__ <br /> ------ Prop. Li <br /> he ------------------ <br /> x <br /> REPAIR/ADDITION(Prey. Sanitation Permit=# ------------------------`-3`3----_,._----- _ Date,.----=--------------•----------_-_-) I� <br /> , 4 . <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) -------- ------"---------- <__�' -------------------------------------- <br /> -------- - .§ ---- -- <br /> --------- -- <br /> 3 -E�-* <br /> ------------------"-----------'? l a <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 wiI1h 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: _ i <br /> I certify that in.the-performance of the work for which this permit is issued, I:shall not �einploy any person in such manner <br /> as to become subject to Workman's Compensation laws of California." ` r <br /> F I. <br /> Signed ------ <br /> --- Yom- - ---------- Owner <br /> 1 <br /> BY ---------- title ��. i. --- -- --- <br /> - -------------"------- -- --------- <br /> (If 0th an owner) <br /> 'FO ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------- --- <br /> . t <br /> ------ ---- -----."- -----------------------------------]-----------------.,DATE----'-'---1;t <br /> l ------------- <br /> ------------------ <br /> F <br /> 17hA, <br /> ]l BUILDING PERMIT ISSUED -------- - ----- ----- ----- ---------- ----------------- ------------------ DATE' <br /> ADDITIONAL M TS - *'N <br /> ------------ -- r- -- -- --- -- <br /> --- ---- - ----- ------------------------------------------------- i ----------------- <br /> ------------ <br /> ------------------- -------------------------------- ---i-- <br /> -------- <br /> - - --- ------- <br /> -------------------------------------------------------------- -----Date .... <br /> JOAQUIN 'LOCAL HEALTH' DISTRICT`" <br /> E. H. 9 1-'68 Rev. 5M r <br />