Laserfiche WebLink
i <br /> FOR OFFICE USE: -APPLICATION FOR SANITATION PERMIT <br /> ,7_6 /� <br /> - _, ;. <br /> 7- Permit No. (G - -�3- <br /> E (Complete in Triplicate) <br /> -------------"-------- ----L- ------ ---------------- .� This Permit Expires I Year From Date Issued Date Issued --_l�="�� <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: <br /> JOB ADDRESS`LOCATION ------ -7 f'S� ! / - ---------------------------CENSUS TRACT -------------- ----------- <br /> Owner's Name -----—,�K-,7-7-9- - ���d�fr----------------------------------------------- -----------Phone ------------------------------ <br /> Address ------ f __,.-- -----,� �+ <br /> --���--�---- - -------------------------->-.. City ----------------------------------•---•------ <br /> Contractor's Name / <r - ! +��t"----- License # �_� � Phone <br /> Installation will serve: Residence Apartment House-0 Commercial :❑Trailer Court i❑ <br /> Motel ❑ Other -------------------------------------------- <br /> f � <br /> Number of living units-----,----- Number of bedrooms ----/-----Garbage Grinder -/I --- Lot Size --- /,/-67 <br /> _ f �--------------- <br /> k Water Supply: Public System and name _f--944- ------------ - " Private ❑ <br /> Character of soil to a depth of 3 feet: Sandf-] Silt[] ' Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe,0 Fill Material ------------ If yes,type ---------------------------- <br /> (Plot <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,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-------------------------------------- --"- Liquid Depth .-------------------- <br /> ! Capacity:-:------------ --- Type --------------- Material------- -- No. Compartments -----------............ <br /> Distance to nearest: Well- ------------------------------------Fou-ndation ---------------------- Prop. Line ---------....:....-•-- 1 <br /> LEACHING LINE ( ] No.. of Lines ___--------------------- Length of each line---------.------------------ Total Length ,____-____-_____.---_------ Q <br /> F DD <br /> 'D' Box ----------- Type Filter Material --------------------Depth Filter Material -------------------------------- ----------- <br /> Distance to nearest: Well - Foundation ------------------------ Property Line. ________.._._._-_-._____ <br /> SEEPAGE PIT [ ] Depth ------------------ - Diameter ---------------- Number ---------------------------- Rock Filled Yes '❑ No'c <br /> r <br /> Water Table Depth ----------------------------------- ------------Rock Size --- -------------------------- <br /> Distance to nearest: Well _--___________________________________Foundation -------------------- Prop. Line __________--______--_. <br /> i <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _____i________________________________ _____ Date -----------------------------------1. <br /> Septic Tank (Specify Requirements) _ ids- ---- � - ff <br /> Disposal Field (Specify Requirements) -- / ----------------------------------------------------------------------------------------------.-------- --------------- <br /> ------------------------- -------- ----- ------------------------------------------------ --------- <br /> R __ ___________________________________________________________________________________ ___._____----_____ <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 /> "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 Workman's Compensation laws of California." <br /> Signed --- --- -- ------ ----- --------------------- - --- ------------------------------------ Owner <br /> IBY `- Title -------- -1 --------------------------- ----------- <br /> (If er than awned <br /> "EPARTMENT USE -ONLY <br /> APPLICATION ACCEPTED B%_- ------------------------------------------------------------------------ <br /> ��� -----------------------------------------------------------------------. DATE /� G�� <br /> BUILDINGPERMIT ISSUED --- ---------- ---------------- ---------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ---------------- -------------------------------------------------------------------------------------------------------------------------------------------- <br /> 5'---------- -------------=---------------------------------------------------------- ---------------------------------------------------------------------- <br /> ------ -------- -- ---- --------------------------------------------------------------------------------------------------------------------------------- <br /> ' -------------------------------- ----- ---- - - ---------------------------------------------------------------------------------- ------------- <br /> Final Inspection by: '- --- - -- -- ------------- --------------------------- -Date ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />