Laserfiche WebLink
/FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> :-.._.: Permit No. ...................'7.S J7 <br /> {Complote In Triplicate) <br /> .................... ............ <br /> .... This Permitfxpiros 2 YeaiFrom Datels=ued Date Issued ._� <br /> r 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. 544 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _103-1" 3----- `/•�1 /t-� S• 'D C <br /> ---- ............. .. ...........................CENSUS ?'RACY <br /> I Owner's'Name ........ .7,t �................... ............ <br /> ._ .,. ..................:.........._.....Phone <br /> r <br /> Address .. ....................................................... -----•_--•..City --- , . % / ..._..:._._.. <br /> Contractor's Name ._ / <br /> .1�C�,.�.....���11�.. ,l���.....5�....Liaense � �.7,�8�:�_ Phone ..��-��'.5...`_ <br /> Installation will. serve: ,' 'Residence Jq Apartment Houseo Commercial oTrailer Court J] <br /> ~ Motel [J Other <br /> Number°o# living units:___.,_._._ Number of bedrooms ... ..-_.Garbage Grinder.. Lot Size ... , G ' --- ---- <br /> liPublic St _.:_.....` <br /> ' <br /> Water supply: an_d-natrle <br /> i `- -------------- ---------�................ ._...... ..--- ...... .- .._.....Private <br /> J�r O <br /> C Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay [] Peat j] Sandy Loom 0 Clay Loam <br /> e <br /> i <br /> Hardpan[] Adobe q Fill Material ............ if yes,type............... ............ - G1 <br /> 4 <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 /> IV <br /> PACKAGE TREATMENT j ] SEPTIC TANK --,�-_-- ��..--...-Size::iC__fx .f-li!-- 3'•i----...... Liquid peptic -��rr....... <br /> a r . Capacity�u� 7 Type/9MaterialeQA0_a77'No. Compartments -. .............. . <br /> "Distance. to nearest: Well ..... r1 Foundation ..../ Prop, Line ' <br /> LEACHING LIN t <br /> E j>'�' No. af'Lines ...•f................. Length of each line.. ....... Total Length ............ <br /> 'D' Box .V0..'. Type Filter Material ..,�'(tC _Dep#h Filter Material ... ....... <br /> Fes. <br /> Distance to nearest: Weil ---- .- -- Foundation ..../0_r........... Property Line ..S.......:.._........ <br /> SEEPAGE PIT. Depth ='.pr... Diameter <br /> .Number ......�2................. Rock Filled Yes No CO <br /> i <br /> t Water Table Dopth .. fJQr".. � _.....Rock Size J��. .�.:� t <br /> r r - s <br /> r <br /> Distance-to nearest: Well --� .............................Foundation ..�..- Prop: line ......_.;..._.._•_.___ <br /> REPAIR/ADDITION(Prev. Sanitation Pe.rrhit ......-------.•---------,_•_____ Date ...................::............) <br /> Septic;Tank (Specify Requirements) ........-•-------------------- •----•---- ....-•..................................... <br /> ......... -T.............. <br /> Disposal Field (Specify Ro quirements) •-•------•-----•••................. ........................... --------------•--- ----... ............. .. <br /> i � i <br /> ------------- -------------------- :...... <br /> 0...--�.. ..................................................................... <br /> j (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will he 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 /> Signed :--- <br /> _ Owner <br /> 1 4. <br /> By ......... ...... -- -----:..__ Title _.. �.?1,r' /�'f.. <br /> (I#other than wner)" ` <br /> .......... .................... <br /> } FO EPARTMENT USE ONLY , <br /> APPLICATION ACCEPTED BY --.-..-. c <br /> Y... --:-- --- -------------------------------------------------- <br /> ---•-------•------------------•- ••--- DATE - • �� <br /> BUILDING PERMIT ISSUED _--•-------.. -------------- ----------DATE ----------------------- - <br /> ADDITIONAL COMMENTS ----- r' - ......- <br /> --•------ ------------------ - -------- ---------- •--- ----- ----------- <br /> ....-.. .... .. p <br /> Final Inspection by: ------ _ . ._ .�,8'�" Date 7Z ?S <br /> EH 13 .2h 1-613 l ev- 5M SAN 3OA UI AL F� TRICT $ <br /> " /74 3M <br />