Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATiON—PIERMIT IN <br /> lr. -A�,_=Permit No.6-------- ---- <br /> ------- (Compie—ioTWfrp—licato) <br /> --=--------------F"__�o----------------- ? <br /> I Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> ---------- ------- --------------- <br /> "- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install 46 work herein <br /> described. This application is made in-complidncd with County .0rdinan6e No.'549 and'existing Rules and Regulations. <br /> JOB ADDRESS/LOCATJON ------ -- -- --- -------------- <br /> -- - -----------------------------:,---CENSUS_TRACT <br /> ------------Phone <br /> ----------------- --- ------ <br /> Owner's -------- ------------- <br /> --------------------------------- 01, ------------------------------------- <br /> i Contractor's <br /> -------- <br /> Contractor'.s Name —-----------------------------------------------------------------License # ------------------------- Pl4one -----------------------_------ <br /> Installation will serve- Residence [Apartment House,M Commercial 7Trailer Court <br /> Motel F-1 Other --------------------------------------------- <br /> Number of living units:.-._._._ - - Number of b drooms _A 4-----Garbage Grinder _1-------- Lot Size ---- ------ <br /> �----- <br /> Privateva_ J <br /> 6�Z!�� <br /> Water Supply: Public System and name ;4 <br /> - <br /> Character of soil to a depth of 3 feet; Sand'o Silt El Clay E] Peat El Sandy Loom D Clay Loom <br /> ❑ <br /> Adobe-E Fill Material -------------[f�" <br /> Hardpan E] �v5e,� <br /> (plot plan, showing size of lot, location of system in relation-to-wells, buildings, etc, must be placed on reverse side.) <br /> ilable within 200 feet,)NEW INSTALLATION: (No septic tank or seepage pit permitted if'pubiic sewer is ava <br /> �5---,rels_ — -------­------ <br /> �,? Depth ___11 <br /> PACKAGE TREATMENT V SEPTIC TANK Size--/6-0------- ........ Liquid <br /> Capacity 0 Material___C - Compartments ---------;�------ <br /> _6�n -; r-W_ ------- No. <br /> Typ�pr <br /> Distance to nearest* Well <br /> ---------Foundation ------------Prop. Line ............. L_ <br /> No. of Lines of each line--/4�511_17 Total Length -------------- <br /> 'LEACHING LINE ------------ <br /> 'D' Box ._------ Type-Filter Material Depth Filter Material <br /> ----------------- <br /> Distancie'to ne rest.'W'611 --------- 'Foundation -----0---------------- Property Line. <br /> Yes C] <br /> SEEPAGE PIT P� Depth ------- lliameter .3 --- Rock Filled <br /> Number ---1�?--------------- <br /> Wd -T 'Depth pth ` Q------------------F--•-------Rock----------Roc --- ------ <br /> eir able - -- ----- --- ------------ k Size <br /> Distance to nearest: WeIlT ---------------Foundation _44" _iP__ Prop. Line _Z----------­_-, <br /> &�/ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------- -------------A_ Date ----------------------------- ------- <br /> -1 "P, <br /> SepticTank (Specify Requirements) --------------------------------------------------------------------------- ------ -----------------------------•--------------------------- <br /> `' Disposal <br /> ----------------1----------------------------- <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------- <br /> ----------------------- ------------------------------ ------------------------------------------------I----------------------------------------------- --------------------------------------------- <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 Laws, and Rules and Regulations-of <br /> ' the San Joaquin Local Health District. Home owner or licen- <br /> sed e agent ,,?g 'ature certifies the following. <br /> "I certif that <br /> n the performance of th_,Ik for which this p6rmit,is issued, I shall not employ any person in such manner <br /> as to bec s bject to Workman's C. <br /> Zect to I 6ronsagon laws of California." <br /> Signed ---------------- Owner <br /> By ------ -------------------------------------- ---------------------------- ------------------------ Title ---65WIwIl----------------------------------------------- <br /> (if other than owner) <br /> R EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------- ----------------------------------------------------. DATE --- -------------- <br /> BUILDING PERMIT ISSUED ----------- --- ---- ------ - -------------------------------------------------------DATE - ----------------------------------------- <br /> - - <br /> COMMENTS -------------- - - ----------- __1r_1__ --- - ----------------------------------------------------------------------- ---------------7------------ <br /> ---------- A::� ;2 r --------------------------------------------------------------------- <br /> -- ---------------- -----------------I------------ <br /> --------------- -- --------- A - ------------------------------------------- <br /> ------------------------------------------- ------ ------------ ------ -- --------------------------V/11�11�7------ -----------/------X----------r�------ <br /> ------ ----------------------- ------- ------------ <br /> Final Inspection by: ---------- ------- -- --------------------------------------------------------- Date --- ;4 - ------- <br /> AQUIN LOCAL HEALTH DISTRICT <br /> E, H. 9 1-'68 Rev. M. <br />