Laserfiche WebLink
FOR OFFICE USE: "� r APPLICATION FOR SANITATION PERMIT <br /> ---------------=------------- <br /> k Permit No. Z <br /> - --- --------------------------------------- (Complete in Triplicate) 3 -Z, <br /> S 2 <br /> _�.._;__, _.._This Permit Ex _ Date Issued ---------- <br /> -----------______,___•-__�--------------------------- pires.l Year Fram_Dafie Issued <br /> 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-mcide incompliance with-County Ordinance-No:-549 and-existing-Rules and <br /> Regulations: <br /> JOB ADDRESS/LOCATION 199_c7_7-_____5------[ lvtoV- AD----------------------- -CENSUS TRACT - <br /> ----- <br /> Owner's Name ---dC--<..........0".,dY_ '�i(!.4n, a--------- <br /> ------------------------------------------------------- ------Phone <br /> . -- ---------------- City ---------------------------------------- <br /> Address 7 " - f ' . � - <br /> - .-..: __ Phone ' <br /> Contractor's Name �- -`-------------- ;License �. <br /> Installation will serve: Residence rg Apartment House�❑ Commercial []Trailer Court, ;❑ <br /> Motel ❑ Other -------- :..._ _� -- <br /> Vn <br /> Number of living units:----.-f --- Number of bedrooms - _----_Garbage Grinder ------------ Lot SizeP-------------- <br /> Water Supply: PublicfSystem and name J-------------- - - -----_.----_ e _----_-_-----.---------Private <br /> 1. ! <br /> -t <br /> Character of soil to_a depth of 3 feet: Sand [ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Q. . <br /> Hardpan ❑ Adobe'❑ Fill Material ------------ If yes,type ---------------------------- <br /> (Plot plan, showing size of I.00t,-location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No sePtidtank or seepag it_permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ I 'SEPTIC TANK i ` GSize-:---- 7` -- 'y��-tel --------- Liquid Depth -_ -----_-_--_._ <br /> Capacity -�e---- Type FV_ Material_C#0n -! No. Compartments <br /> -- <br /> t Distance-to nearest: Well ------ ----E -_----1"..-Fou-ndation ZIP--------- ----- Prop, Line ---c'r?............... <br /> • <br /> LEACHING LINE [,�No. 8f,,.Lines --.- ------------ Length of.;each lirie&iAvaar___70-,- Total Length <br /> D' Box "4---.-.--- ;Type Filter Materia! -'I - Depth Filter Material ---/7 -------------------------- <br /> I -:: f --------------- Property Line. ---�---=-----_ <br /> ' istance to�befarest: Well --_ -— ----_-- Foundation --- <br /> j SEEPAGE PIT Il�1' �k pth -.__CS'_-.--_------ Dia er yx. __ Number"----------------It-------___-- ock Fill d Yes 00 <br /> I r <br /> Water Table Depth __°-- ----------- -_-__-_--_._-.--------Rock Siz -- -Z.� ---�- -• / <br /> Distance to nearest! " ell ------ gafa -.. __----_-_...Foundation -._lQ__..._- .- Prop. Line --- <br /> S <br /> REPAIR/ADDITI (Prev anitation Per # -------------------- ----==-------------- Date ----------------------------------1 <br /> 4 <br /> Septic Tank (Spe fntsl F ------------------------------------ , <br /> bisposa Field {Specify Requirements) -- ------ ------ -------------- --------------------------- ------------------------ ------------ <br /> f �` e - -----•------------------------ <br /> ------------------------------ <br /> �F <br /> v. ----------- =-- .. _ -----=------- - "---- - ---- - - - - - - <br /> (Draw existing and required.addition on reverse side) LL <br /> I hereby certify that I have prepated this application and that the work will be done in accordance with San Joaquin <br /> Y fY <br /> County Ordinances, State Laws, and Rules and Regulatians,.of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies tate following: "r- <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 Wo man's Compensation laws of California." <br /> Signed Owner i <br />� 9 ----------- �--------------------------- - � .Title <br /> Ufa <br /> ---------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE, ONLY <br /> APPLICATION ACCEPTED BY ' ------------------------------------------------------------ ------- DATE --- <br /> IBUILDING PERMIT ISSUED ---------------------------------------------------------------------------DATE ---------------------------------------•--- <br /> ADDITIONALCOMMENTS - ------ --- -------------------------------------- --------------------------------------------------- ------ --------------------------- <br /> --------------------- - -------------- -------------------K <br /> -------- - <br /> ------------------------------------- -- ------- --- --- -------- - ----------------------------------------------- ------------------------------- <br /> - ------------------- ----- ----------- --- ---- --- - ------ ------- - -- ----------------------- <br /> Y Final Inspection --- - -- --- ----- --- - ------------------------------ Dat. ' <br /> SAAN JOAQUIN LOCAL HEALTH DISTRICT <br /> { E. H. 9 1-'6$ Rev. 5M <br />