Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT _ a <br /> ------------------------ -------•------------_•-- Permit No.. -��--/�-- <br /> - ---- (Complete in Triplicate) <br /> -------------------- ---------------- 7 <br /> Date Issued <br /> ______I This Permit Expires 1 Year From Date Issued <br /> Application is hereby mal a 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 /> JOB ADDRESS/LOCATIO,,N� --/-ef_33��---- 4 �-------------------------------->---------------CENSUS TRACT --JIVII----------------- <br /> Owner's Name ------��"_-- ------ sin r---------------------------------------------- ------------------------ <br /> Phone ----------------------------•------ <br /> 1 CitAddress .��--`����.2"-----------�'- -t---�----�-----�-----------=------------- -.- • y -,--- -- - --- - ------------------------------------....---•------ <br /> Contractor's Name -- -i -«--• .41x"r'' ------.License # ------------------------ Phone ---------------------------- <br /> Installation will serve: �� Residence,( ]Apartment House❑ Commercial :❑Trailer Court ❑ <br /> Phone <br /> t 1 <br /> Cantracto Address �` �c ` 7jx,�( <br /> 3'=-'`. ...... ............ .,r...,.........---- Z� t ..Lir PgcP-Nn- _ <br /> ------._.. _.. <br /> �M <br /> Water Supply: Public System and name ----------------------------------------------------------- ---------------------••--------------........-- -Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam JD Clay.Loam ❑ <br /> M <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- <br /> (Plot plan, showing sizelof 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) <br /> PACKAGE TREATMENT {�] SEPTIC TANK'[ ] Size----------------------------------- ------ Liquid Depth ---------------._..-----_. r <br /> Capacity _--------------- Type -------------------- Material---------------------- No. Compartments ------------- <br /> W <br /> Distance to nearest. Well ------------------------------------Foundation ----------------------.Prop. Line --------------- ------ BVI <br /> LEACHING LINE [ ] No. of Lines ---------------------__ Length of each line---------------------------- Total Length --------- ---_-_-__•-.-_--- F" <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ------------------------------ ............. <br /> II <br /> UIStance to nearest: Well _______________________ Foundation ------------------------ Property Line ---_-_---_---_--...._.-- <br /> I <br /> SEEPAGE PIT { ] Depth -------------------- Diameter ---------------- Number ------------ --------------- Rock Filled Yes ❑ No ❑ <br /> Water Table Depth ------- ---------------------------------------•Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- <br /> Is <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --_---___---_-______._..___-____--j <br /> .p (Specify . equirements) ---------------------------------------------------------------------------------- ----------:------------------•---------------------------- <br /> Disposal <br /> -------------------------- <br /> Di <br /> Septic Tank (S (Sp Ry Require. entsI L 1r _� cam- 's�.�' ,. y - � `� .� '------------------- <br /> ------------------------`----------------------------------------------_------------------------ <br /> Dls osa Field S eco <br /> --------------------------------------- I1-------------------------------------- --- ------------------------ <br /> - - - ------------------------------------------------------------------------------------------- <br /> ' (Draw existing and required addition on reverse,side) �- -_�•-�-�: -`-�--- - 1" <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 the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <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 tQ-Workman's Compensation laws of California." <br /> Signed ----- ------- -- <br /> By ------ -- - -- -- Owner <br /> - <br /> ---------- Title _ ------------------------------------------------------------- <br /> If other thalI n owner] <br /> it FOR DEPARTMENT USE ONLY <br /> h ----------------- DATES"7� --------- <br /> APPLICATION ACCEPTED BY --------- -----�I/-'�--'!-�'-E<Goc!r---------- ------------------------ --------- <br /> ---------- <br /> BUILDING PERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------------------------=------------------- ------ <br /> II <br /> 0M----------- ----------------------•-------------------------- <br /> ----------------------------------------iM <br /> -------------- <br /> Final Inspection by: --------IM / .- ?�+ - -- ------------------------------------------ ---------------- Datelcz- � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br /> II <br />