Laserfiche WebLink
7r !! <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No: _�'__I.3 <br /> (Complete <br /> ---------=----------------------------------------------- p p <br /> �� in Tri licate) <br /> ----------------------------------- <br /> i`__-.--- This Permit Expires 1 Year From Date Issued Date Issued <br /> !I <br /> ...._ Application is hereby malde 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 /> I� 1 iF <br /> JOB ADDRESS/LOCATION ------=�- -7---- :- (S`:-------- ------ ----- -----------:----CENSUS TRACT -------------------r•-- <br /> Owner's Name aq.c-,-------- -------Phone -7-7 a � -•-. <br /> Address ------------------ / n?-- -----------U)_--------CA0' ---------------- Cit --------------------------------••--•---- <br /> Contractor's Name _____ ' lo-71107 <br /> �, '-.- `---`fit--S -"---'---",.._.License # ---r'��` 3---(Phone - <br /> Installation will serve: Residence[�Apartment House Commercial :E--]Trailer Court ;❑ °k <br /> Motel ❑Other ------------------------------------------- <br /> Number of living units:__( <br /> -- Number of bedrooms ._-A__Garbage Grinder ------------ Lot Size _ :---_____________________________________ <br /> Water Supply: Public System and name ----C ___. ------epi------------------------------------- Private ❑ <br /> I <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat El Sandy Loam ❑ i!Clay Loam ❑ <br /> Hardpan ❑f AdobeFill Material u---______- If yes, type n---:______:______________ <br /> r <br /> (Plot plan, showing sizelof lot, 10ation of system in relation to wells, buildings,•-ef}. must'bei.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'[ 1 Size--- --p------------------ <br /> ------------ '-------------------- Liquid Depth -----------------•--:-- <br /> - <br /> r; <br /> Capacity 6------ --------- TYPE -------------------- Material----`--� ----------- r No. Compartments --------.............. <br /> ------------ --------- - -----------Fouridafiion Pro Line <br /> istance`�to -nearest. Well _ Total; p <br /> D - . -e---- Len .. <br /> LEACHING LINE [ ] �o. of Lines 't _____-�- Length of each line _-._-- �k Length. ----: ---------------------- <br /> .'iD' Box ------------ Type Filter Material -_----- ------------ Filter Material -- --------------------------------------- <br /> Distance <br /> ,i <br /> Distance to nearest: Well _______________________ Foundation _.________-__--*`""____ Property Line ------------------------- <br /> 0 <br /> �- c <br /> I 3 ,- Number �_______-___ Rock Filled Yes Q� No i❑ <br /> i Depth ----�� - Diameter ----------- ----------------- <br /> SEEPAGE PIT D _ i ., I <br /> [ <br /> Water Table Depth ----------------- ---------------------- `-----Rock Size -- /fix -------- <br /> Distance to nearest: Well ----------------------------------------Foundation -- <.,------------Ip Prop. Line <br /> ....----..------------ <br /> il I ,_, <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ___________________ _.__._______ Date ----------------Y_____________- -) <br /> ---------------------------------------------- ----- <br /> Septic Tank (Specify Requirements) ---- ---- -- "' <br /> Disposal Field {Specify Requirements) _______________ ---------------- <br /> 1 5 <br /> - <br /> ---------------------------------------I�---------------------------------------------- --------- --------- - -------------------I---{----------------"I-----------------`-•-------------------•-- <br /> IF I ----------------� <br /> (D)raw existing and required addition on reverse side)� . <br /> I hereby cern that 1 haveprepared this a application and that the work will 6e done ,n acco <br /> - ----- - - - --- <br /> y fy pp dance 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 Haat in the performance of the work for which this permit is issued,4,shall not employ any person in such manner <br /> ..�...+...r.r +•.�w7a it € <br /> as to become subject to Workman:, 's Compensation laws of California."— --�.� <br /> Signed •----------------- - Owner i <br /> BY --)� Ither than <br /> __� 1 're"��'-Title ----------- ------------------ -----------i <br /> --- ---- ------- <br /> n owner)" <br /> !I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED� BY ' ---- -------- - ------------- DATE ------ -- ---------------------------- <br /> BUILDINGPERMIT ISSUED -----------------I---------------------------------------.`----------------------------------=--------------DATE ----------------------------------------- <br /> ADDITIONAL COMMENTS __.________..__--------------- -µ-- <br /> ii ------I------------- <br /> iI <br /> ---------------------------------------- ---------- ----- P�----=------- <br /> ` ---------------------------- -- ----------- --------------- - m��-� <br /> Final Inspection by: --------`k------------- ----- ----------------�-------------------- ------------.Date -�1---�--------- - -- -----------•------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5A,1 , <br />