Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------------------------------------------- <br /> ---------- <br /> (Complete in Triplicate) Permit No. _7--------------- <br /> --------------------------------------------------------- <br /> --------__________________.__-_______.__:_______ This Permit Expires 1 Year From Date Issued <br /> Date Issued - /—X-_71 <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 made in compliaanjce�with <br /> '� County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION 7 -2 ` �-z-�-� <br /> - - -----�-=------------------- ---------CENSUS TRACT -------------- ........... <br /> Owner's Name ----------- 14 .---= -- ?. Phone <br /> ....._ <br /> Address -------------------- VY ? �Z- ---- Cit " <br /> Contractor's Name n� = ='may -._.License #� �:3. _ Phone --------------• --__------- <br /> Installation will serve: Residence artment E-�ouse,❑ Commercial []Trailer Court ❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number <br /> -------------------------- ------Number of living units: ___ __.,•Number_of bedrooms. __.___.Garbage Grinder__..:____.Lot Siie ___ ✓t -6t. ---------- <br /> Water <br /> -�-..,.,.+..G....�-.-.: �i.-� ��...rw+mow"^ ... - _____-_. <br /> Water Supply:'Pub'lic-Syst`e`rri and ria`rrte --- -- •- - -- ---------- ---- -- ------------------ - .... -- -- --- ------Private ,-� <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ CIaYz`E]' -Peat❑ \Sandy-Loan Clay Loam ❑ 1 <br /> Hardpan ❑ Adobe ❑ Fill Material;- _ �Ifyes;`ty �------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings\etcf must be placed on reverse side.) <br /> e <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewerjs available within 200 feet,j <br /> r. jt� '.. _e V <br /> PACKAGE TREATMENT [ } SEPTIC TANK:[ ] Size________I•___________._-t._ ,_------�__-__--Liquid Depth -------------------------- <br /> Capacity ------------------ <br /> ________________________Ca acit - Type -------------------- Material----------- _':_ -•No Compartments <br /> t_ Distance to nearest. Well ------------------------------------Foundation ---- -------------- Prop. Line ----.----------------- <br /> r <br /> LEACHENG LINE [ ] No. of Lines ------------------------ Length of each line._.._.____ ___ _____ Total Length _____-____-__------______- <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ---------------------.----------------------- <br /> fiDistance to nearest: Well ________________________ Foundation ------------------------ Property Line ------------------........ . <br /> SEEPAGE PIT [ ) Depth __________________ Diameter _______________ Number -------- ------------------ Rock Filled Yes ❑ No <br /> Water Table Depth i <br /> .� -------------------------- ----- --------------Rock Size ---------="•------------- --•--- � - <br /> ' Distance to nearest: Well ________________________________________Foundation _________________-`Prop. Line ________--____.---.-.-. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date -----I---------------------- <br /> Septic,Tank (Specify Requirements) ---------- --- --- ------ __ ---:------ _---_. <br /> ------ + <br /> - ------------------ ------------- --------------- <br /> Disposal Field (Specify Requirements) ___ --------- - _ -------- <br /> --------------------------------------- <br /> ----'=-- ------ --- ------------- <br /> k (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 /> t County Ordigances, 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 thaf 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 Workman's Compensation laws of California." <br /> Signed ---------- ------------------ R - Owner <br /> - -------------------- - - -- <br /> BY = --- -°° -- Title ----------------------------- <br /> �[If othee r than owner} I <br /> FOR DEPART T USE ONLY <br /> APPLICATION ACCEPTED 'BY _ --------- <br /> - = DATE -7 — <br /> 4 BUILDING PERMIT ISSUED ------------------------------------------ <br /> ------- ----------------�----------- - - ------=--------------DATE ------------------------------------ -•-- <br /> ADDITIONAL'COMMENTS-:------------------------------- ---------------------------------------------------------------- <br /> ------------------------------------------------ ---- ---------------- -------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------- -- ------- ---- ---- -------------------------------------------------------------------------------- <br /> -- -- 7-Z------------- ------- <br /> Final Inspection b = - -------------------------------------------------------.Date ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />