Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------- -------- -------�-- -------- ----------- t Permit No: . --_ <br /> ! (Complete in Triplicate) -� ,-5.-3-.0 <br /> ---------- - ------------------------------------- <br /> = ------------ This Permit Expires ] Year From Date Issued Date Issued __�__ x_7767 <br /> I 1\ <br /> Application is hereby made to the San .Joaquin Local Health District for .a permitr to construct and install the work herein <br /> described. This application .is,mdde in complianc4,with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCA NtG!..-�tJ3�' -`- ---- 1`u-- - ?- 'ar.- NSUS TRACT <br /> � -_ <br /> Owner's Name -- --- ^ ---� ----- -`�'-- ---------------------------- -------------------=�--------- ---------Phone --------------------------- <br /> Address ----- --- ---- ------------------ --------------------­. City - ----- . - --- ------------------------------------ <br /> Contractor's <br /> _ ---------------------•---•--Contractor's Name - --- '�"`tir' -- License # _ c 3� Phone <br /> --- <br /> Installation will serve: Residence [F'Apartment House❑ Commercial ❑Trailer Court ',❑ <br /> " Motel.❑Other --------------- --- <br /> -______--I--_ ---------------------- <br /> _ <br /> Number of living units: ...../__. Numbei ofbedrooms� -_Garbage Grinder --------._._ Lot Size ------------ <br /> ------ ------------------------- <br /> Water Supply: Public System and name ______:____ `-P-= , -- � -_ -& - _-___--Private [71------------------------- <br /> -_ ------- <br /> Character of soil to a depth of f 3 feet: Sand'❑ Sift❑ Clay ❑ Peat❑ Sandy Loam [ Clay Loam ❑ <br /> r ryHardpan ❑ Adobe '❑ Fill Material ----------- If yes,type ------------------------ -k <br /> t, � <br /> (Plot plan, showing size of lot, Vocation of system in relation to wells, buildings,, etc. must he placed on reverse side., <br /> NEW INSTALLATION: --(No septi tank or seepage pit permitted if public sewer is available within 200 feet,) r <br /> PACKAGE TREATMENT ( ] SEPTIC TANK'[ ] Size-----------=--=------------ ::=-`-------I- Liquid Depth -------------------------- <br /> CbpacitYT - Type -------------------- Material---------------------- No. Compartments --------------------- P <br /> a <br /> J� � Distance to nearest: Well ---------- -------------------------Foundation ---------- ------------ Prop. Line ----------------------- <br /> � <br /> LEACHING LINE [ ] No. of bines?x---t------------------- Length of each line-----------------.---------- Total Length ------__--___ <br /> --------------- <br /> i I 'D' Box -------- --- Type Filter Material --------------------Depth:-Filtee Material -----------____-- <br /> ' ---------------------- <br /> Distance'"t'o'nearest: Well ______________________'"-Foundation ------------------------ Property Line. -- _________-.__ -_. _ <br /> SEEPAGE PIT Depth= __ '_�___:__:_ Diameter, :::_--__ __- Number --- __- __ Rock Filled Yes E] No <br /> i❑ <br /> � <br /> Water Table Depth .: ---------------------- Rock Size <br /> i I ---- -----Foundation <br /> I <br /> Distance 'to nearest: Well ----------------- ----------- - ------------- ------ Prop. Line -.-- ----------•-•--.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit e# --------.- --------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) --------------------------------------------------------------------------------- <br /> Dis osal Field (Specify Requirements)I ; <br /> ----------- <br /> ; <br /> ----- -- -- ----___ r. ^Y . ----------------------- <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 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 s t to Workman's Compensation laws of California." <br /> Signed -------- ------------ --- Owner _ <br /> ---- - ----- <br /> BY Vic-'.R- � <br /> 'R' ------ Title ------"--�----- <br /> ---------------- <br /> (If other than owner) �L <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-_ _ _ _ -- - _--------- DATE . :�f- <br /> --------------------- - - ---------------- <br /> BUILDING PERMIT ISSUED ------------------------- ----------------------- --------------DATE - -------------------------- <br /> ADDITIONAL COMMENTS -------------' <br /> -------------------------------------- ---------------------------------------------------------------------------------------------------- -------------------------------------------------------------- <br /> ------------------•--------------------------------- <br /> ----�--�--- ---- <br /> SAN J _FinalInspection bY OAQUIN <br /> LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />