Laserfiche WebLink
FOR OFFICE USE: 07!5-3 <br /> APPLICATION FOR SANITATION PERMIT <br /> -----------------------------•---------------- <br /> (Complete in Triplicate) Permit No. ._�l_�-._�_ <br /> ------------ -------------------------------- <br /> r''r Date Issued <br /> _____________------------- ------- _-_I_ This Permit Expires 1 YearNFrom Date Issued <br /> Application is hereby made'tofihe San Joaquin Local Health'District for a permit to construuct aar5d install the work herein <br /> described, This application is made in compliance witKCounty Ordinance No. 549 and exi ting Rules and Regulations: <br /> JOB ADDRESS/LOCAT N11�c1_ <br /> -----CENS TRACT -_______ <br /> I <br /> Owner's Name J?aYf =---------------=- -------Phone� � 1------- <br /> Address -------------- =- ----------------•---.City ------------------ ------------------- <br /> Contractor's Name __._ ___ ____._.! __ _ ____ ___�Cf --------1_,�____y_.License # AZ /------ Phone <br /> Installation will serve: Residence75dApartment House❑ Commercial �❑Trailer Court ;❑ <br /> Motel ❑ Other -------==`_*------------------------------ <br /> Number of living units:----I_----- Number of bedrooms __3___�Garbage Grinder ------------ ,Lot Size••----_ .______ ___ __________--_.__ <br /> ._Water Su l'`�P blit-S' stem and name„- _ `w-�=_- _-----' �+�_-_= 1 ----Private - <br /> pP Y - hl. <br /> Character of soil to a depth of 3 feet: Sand'❑'' Silt o .Clay ❑ l Peat❑ Sa'ndy Laam;O., Clay Loam ❑ <br /> Hardpan ❑ Adobe '❑ Fill Material ________--lf yes,type,-___ -. -------------- <br /> (Plot <br /> ___- --____(Plot plan, showingfi"size of lot, location of-system-in—relation to wells, buildings, etc.}must_be placed on reverse side.) <br /> i4i ell <br /> f NEW INSTALLATIO;:"" {No septic tank or seepage pit permitted if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT �-' [ ] - ---- Liquid Depth -------------------------- <br /> [,�}.� SEPTIC SANK-+-�._.._-___..� ISize------- --------�------------�--------- <br /> t Capacity ---- --------------- Type ----------1--------- Material------------ --------- No. Compartments ------•--- -------•--- <br /> Distance tonearest: Well ........................Foundation ---------------------- prop. Line --------..._._........ <br /> i LEACHING LINEt[ J No: of Lines ___ ___ `.__ E ength of each line____.__.__.-I--------------- Total Length ---------------------------- <br /> � t. <br /> + 4 <br /> ola� D�1Box�----�- --- Type Filtuer Material -------------------:Depth Filter Material -------------------- -•--------------•----•- <br /> Distance to nearest: Well _____________t_________ Foundation ________________________ Property Line --------- -------------- <br /> i <br /> f� <br /> SEEPAGE PIT [ ] Depth _ Number _ ----------------- Rock lied Yes ❑ No i❑ <br /> Diameter <br /> I <br /> Water Table Depth ------__ ' --------------- <br /> --------------------�_.._---....------.!Rock Size -------------•--- .. If.t. <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --- - ---------._....----.------_) c1 r <br /> Septic Tank (Specify Requirements) ----------------------------------------- - --------- ----------------------------- ----- <br /> Disposal Field (Specify Requirements) -------- - = ° ------------•- <br /> _ - _ - - - = _ _ - ------------- <br /> r' ..t ------_ <br /> ---------- ---------- ----------------------------- - -- --------------- <br /> (Draw <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'Lows, and Rules and Regulations of the Soh.Joaquin Local Health District. Home owner or licen-�'� <br /> sed agents signature certifies the following: ''��►` � ` L <br /> "I certify that in the performance of,the work for which this'-' ermit is issued, I shell not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ----- - -- - ----- - -- -- -- - `�_-'--------------------------- Owner <br /> Yi Title - • - �^ <br /> ----------------------- <br /> ( of r an owner) <br /> FOR DEPARTMENT ILY '} <br /> APPLICATION ACCEPTED', $Y =` 1 _. I_t DATE ---��� / '��-----------------=- r <br /> t ,. <br /> BUILDING PERMIT ISSUED ----------------------------------------- ------ ------------------ --- ----- -------DATE --------------------t- ------ t ti <br /> ADDITIONAL COMMENTS - #-------------°---------- ----------------------------=--------1 <br /> ----------------------------------------------------- 1 f <br /> I <br /> ------------'-'--____- ---------------- ---- - - _ --------------�.----..--..-.�-�. <br /> --------------------------------------------------•-------------------------------------_';�t------ <br /> --------- -- --- -- <br /> Final Inspection by ------------ -----� C <br /> E - -- - <br /> ' <br /> - " # Date = "�� �� <br /> OAQUIN -LOCL-'FEALTH- SAN STRICT µ-µ �--- <br /> E. H. 9 1-'68 Rev. 5M <br />