Laserfiche WebLink
FOR OFFICE USE: <br /> O APPLICATION FOR SANITATION PERMIT <br /> r.. ...... _4_.................I.............. (Complete In Triplicate) Permit°i+Ia• . <br /> ........................................................ This Permit Expires t Year from Date Issued <br /> Date Issued . :�%'_.2.} <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 compliance with County Ordinance No. 549 an existing Rules and Regulations: <br /> ` /�... sic r <br /> JOB ADDRESS/LOCATION —3.&7Iv. .�L °,4 ,?.CENSUS TRAGI <br /> Owner's <br />« s. Name ._._....... .................. <br /> e... ' <br /> ................... <br /> ......................Phone <br /> Address .............. . ...................... '.3..,.1...-...�.i..C�rr..-.. .. _--__ <br /> _ <br /> ................ .. .............. CityX:M <br /> Contractor's Name <br /> . -_ Ste! �,.-¢'rte_•--..license ........... Phone ..!y_!� 6 1p6e7---- <br /> `installation will serve; Residence Apartment House(3 Commercial❑Troller Court ❑ <br /> Motel ❑Other............................................ <br /> Number of living units:...I..... Number of bedrooms _.-...Garbage Grinder _.._......-_ Lot Size ....Agmew_------------------ <br /> Water Supply: Public System and name ................................._._..........................-................-----------...............Private . <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam d, Clay Loom❑ <br /> Hardpan❑ Adobeg Fill Material ............ If yes,type............... ............ <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 ....................... W <br /> Capacity ----------------•--- Type .................... Material------••-----------_- No. Compartments ...................... <br /> Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... J <br /> LEACHING LINE [ No. of Lines ------------------------ Length of eachline.._.......................... Total Length ............................ y <br /> 'D' Box ......___... Type Filter Material ....................Depth .Filter Material ............................................ <br /> Distance to nearest: Well ------------------------ Foundation .....-_.- .............. Property Line ........................r <br /> SEEPAGE PIT { j Depth _----------------- Diameter ......._..:..... Number ............................ Rock Filled Yes ❑ No <br /> OF <br /> Water Table Depth ------------------------------------------------Rock Size ............................. J <br /> Distance to nearest: Well .__.....................................Foundation .................... Prop. Line -----.__....__--•-••-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........._.................................. Date __..--..-----.-------------------_) <br /> Septic Tank (Specify Requirements) ......... �............... ........................... ....... •-........-................. <br /> Disposal Field (Specify Requirements) .�f:'�.*..�__��..._�-►C-L!:'1•. �-(�..C--�..�_RJg_t.N......---•------------------•--•------_-.--- <br /> ..........•.-.----•-•----------------............ <br /> Q..._ <br /> -­---------­----------- <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 the San Joaquin Local Health:Distdct. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "1 certify that in the performance of the work for'which this permit Is issued, t shall not employ any parson in such manner <br /> as to become sub(ect Workman's Compensation laws of California." <br /> Signed -. /- - -k_ 14.P_P1_XS!~l._�.�o.N.,S <br /> By ..... •-••----•----------•----------- , "0-4 __ Title __. ------------------------------ <br /> (if other than owner) <br /> FO DI; TM€NT USE ONLY <br /> APPLICATION ACCEPTED B ----------- ------ DATE --,�_7-- ...... I <br /> BUILDINGPERMIT ISSUED ---------------- ...... --------------•---- ............................................................DATE -------------_--- ...................... <br /> ADDITIONAL COMMENTS ------------------------------ _...._ <br /> - ------•--•------ ---------- ---------------- --•-••--------........_._.._•••--- <br /> ... ------•------------------------------------------------------------ --------------- --------- <br /> -- ---------------•--••---•- • ----•--------------••-------- --._ .--- <br /> Final Inspection by: .._/(.-•-• -_-------......................Date.. <br /> EH 13 2h 1-68 V. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71; 3M <br />