Laserfiche WebLink
.,Ft�R OFFICE USE: <br /> APPLICATION 1=0R SANITATION PERMIT <br /> ' Triplicate) <br /> Permit No. <br /> ---- <br /> ��,, [Complete in Trip icate <br /> ----------------- <br /> ------------------------------------ <br /> Date Issued <br /> --- This Permit Expires ] Year From Date Issued - <br /> Application is hereby made to the San Joaquin Local Health District for a per 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: y <br /> JOB ADDRESS/LOCATION . ----- -�.I �I- ---- �:I.�•---C�..QLl�t2.:---�p---------------------------------- ..... TRACT573--.----------- <br /> I fl`� 5. �_pA-C2G <br /> PhoneSa5'____Jb_3T9------------- <br /> Owner's Name ------ <br /> Address --------------------- ------------------------------------------------ • CitY --- A � --- ------------ --- <br /> --------------------------•------ <br /> Contractor's Name -------- ----------CTL@�)L'i'zfL-------------------------------------------------Licen <br /> se # ------------------------- Phone ------------------------------ <br /> Installation will serve: Residence 01(partment House❑ Commercial ❑Trailer Court i0 <br /> Number of livingunits:____ l Number of bedrooms ___ Garba a Grinder lot Size - <br /> f Motel [I Other --------------------------------------------c� -- <br /> Water Supply: Public.System and name ------------------ --------- -------------------------------------------------------Private D�_� <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom 0 Clay Loam .0 <br /> Hardpan ❑ Adobe'[rFill Material ------------ if yes, type ---------------------------- <br /> (plot <br /> --------=----------------- <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,) �f� ` <br /> F PACKAGE TREATMENT [ ] SEPTIC TANK f Size---_1- -`'s---�a- -- ---------------- Liquid Depth ----------` ----:----- <br /> - . - + . Compartments ------------•.---- <br /> Capacity 1Da_- --- <br /> Type ---- -� -- -- MaterialF Foundation -------- k � V <br /> P • Y - - YP <br /> Distance to nearest. Well ------ __----------------------- <br /> _ ----_ __ !'_-------- Prop. Line _____s�...,__--.-__ O <br /> I _ Length of each line______�0--------------- Total Length .---� D--------- <br /> LEAC1-IING LINE [ ] No. of Lines __-__- ----- <br /> -------------- <br /> 'D' Box -- _- -- Type Filter Material �_e'JROL-----Depth Filter Materia( --------� - ------------•- ----•------ <br /> Distance to nearest: Well -----cP------------- Foundation --------IP`_______ Property Line -------$-_--_-__....._ . <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number --------------- Rock Filled Yes ❑ No 0Q <br /> Water Table Depth ------------ --------Rock Size -------------------•------------ <br /> Distance to nearest: Well --------------------------- ------------Foundation -------------------- Prop. Line ---------------.._.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) --- ---- ------------------ ------------------ ------------------------------ 4 <br /> Disposal Field (Specify Requirements) -------------------------- -------------------------------------------------------- <br /> ----------------------------------•--------------- <br /> - - <br /> -------------------------------------------------------- -------------------------------------------------- <br /> ------------------------------------------------ --------------------- <br /> (Draw existing and required addition on reverse side) ' <br /> I hereby certify that 1 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 Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> r �- I certify that in the'performanc f e work for which this permit is issued, I shall not employ any person in such manner <br /> as tobe a subject to Wor ompensation laws of California." <br /> Signed _. ------ Owner <br /> BY/ _______ - ------------------------------- <br /> -------------------------------------- <br /> ------------ Title --------------- ---------------- --------------------------------------- <br /> (If other than owner) <br /> } FOR DEPARTME U LY <br /> 7jYL- <br /> APPLICATION ACCEPTED BY ----------------------------------------- ------- --- -�= DATE ------------ ------------- ------------- <br /> BUILDING PERMIT ISSUED ----- ------------ ----------------- ---- f DATE <br /> ADDITIONAL COMMENTS --------------------------------- ------- ------------------------------ <br /> -------------------------=-------------------------------------------------------------------------------- <br /> Iq--------------------------------------------------------------------------------------------------------------------------------- <br /> ---------=------- <br /> —� . <br /> --------------------------------- .... <br /> -- - --- - ----------------------------------------------------------------------------------------------- ---- <br /> -- <br /> --- - - - <br /> Final Inspection b ------ .Date <br /> P Y <br /> �e <br /> SAN JOAQUIN LOCALHEA-I.TH DISTRICT 0 <br /> C, <br /> E. H. 9 1-'68 Rev. 5M G <br />