Laserfiche WebLink
F�JR OFFICE USE: APPLICATION FOR SANITATION PERMIT / <br /> �,X g `--�-fJ Permit No. &121----- `_4-� <br /> (Complete in Triplicate) <br /> This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> _ _ _ _ <br /> ----------------------------------- _ -- ----__ __-__ <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 ./Z -,,:f-1,9A41 CENSUS TRACT --------------•----------- <br /> 13- l >S ' �� -moi -T ,rr3 'r_l .cF - v,9L-- 'Oi% h°one ----------------------------------- <br /> Owner's Name -��__(�� - - <br /> i <br /> Address ---------------------------------------------------------- <br /> -------------- City <br /> Contractor's Name -le_ -- LL -----t--- 1c�--------------------------=--------License # :�� _3__ Phone .- <br /> Installation will serve: Residence?}-Apartment House-[] Commercial :[Trailer Court ;❑ <br /> Motel ❑Other ---- ----------------------------- -------- <br /> r r' <br /> Number of living units.._/-_-.--- Number of bedrooms :3-------Garbage Grinder -----_-____ Lot Size / -- ---X_-a_2_QQ-------------- <br /> Water Supply: Public System and name -------------------------- --------------------------------------•---------=---------------- ---------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe-[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 I ] Size------------------------------------------------ Liquid Depth ---_---_----.--.__---.-_-.. <br /> Capacity --------------------- Type -------------------- Material---------------------- No. Compartments ------ .......... 1 <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -------------.-.__-_-- <br /> LEACHING LINE [ ] No, of Lines _.------------------- Length of each line --------------------------- Total Length ----------------- ...___ <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 i❑ <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation ---------------.---- Prop. Line ---------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------.-------------------) a <br /> SepticTank (Specify Requirements) -------- -------------------------------------------------------------------------------------------- ----..-------------------------------- <br /> Disposal Field (Specify Requirements) --&0_ ---------- ----„ lT-------- <br /> ------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- ---------- <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 ubject o W Tkman's Compensation laws of California." <br /> Signed ------------------------------------------------------------------ Owner <br /> By ----------------- - ---------------------------------------------------------- Title ---- ------------------------------------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ---------------------------- DATE ~ <br /> BUILDING PERMIT ISSUED ---- -----------------------------------------------•-------- ---------- <br /> ----- --------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS --------------------------------------------------------------------------- ------------------------------------------------- --------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - ------- ------------------------------------------------ ------------------------------------------------------------------------------------------------------------------•-------------------------- <br /> - <br /> ----------------------------------------------------------------------- ---- -------- - ---- { <br /> Final Inspection by. .-- ------------------------------Date --------------- --�� -------- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E- H. 9 1-'68 Rev. 5M <br />