Laserfiche WebLink
5 <br /> FOR OFNC USE: <br /> f' APPLICATION FOR-SANITATION PERMIT . <br /> ' ... ......................... <br /> v.. ...-............0 <br /> (Complote in Triplicate) Permit No. .. <br /> Date Issued <br />__.__.-.-,....... ............a..- .................. This Permit Expires 1 Year From Date Issuer! <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 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION ........ C.1 - ..-. .+-...... r..Kt!f �'01�.......................................CENSUS TRACT ......:.......... <br /> ......... <br /> Owner's Name 1' � /`— �f P� ..............................................:....................Phone....--•-----•._.... ................ <br /> ��Address �.....--- ........................................................... City �/�s-9 s......-........ .. <br /> Contractor's'Nome .... a V0/ ..................._............License # :.-► 3 ,Phone 150Wf::71XM..... <br /> f, <br /> Installation will serve: Residence,%Apartment House Commercial❑Trailer Court 0 <br /> Motel ❑ Other ..................................... <br /> Number of living units:-./...... Number of,.,bedrooms ... .....Garbage Grinder ./_ 6.19.- Lot Size ............. <br /> Water Supply: Public System and name .....t......--•...........................................-•--........--=--...--••.....--•..... .. ...........Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ - Peat❑ Sandy Loam ❑ Clay'Loom ❑ <br /> Hardpan ❑ Adobe-0 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 ................ <br /> ! Capacity .................... Type .............. Material................ No. Compartments ......... <br /> Distance to nearest: Well <br /> ........................Foundation -------- .... ---- Prop. Line pD <br /> LEACHING LINE ( ] No. of Lines ------------------------ Length of each line--------------------------- Total length <br /> 'D' Box ------------ Type Filter Material ....................Depth 'Filter, Material ................_........._............. <br /> :_.. .� <br /> Distance to nearest: Well .....:...........c...:.. Foundation ........................ Property Line ........__ ....... <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter -............... Number ----.-----.----------.__--.- Rock Filled Yes ❑ - No (:3 <br /> Water Table Depth ____Rock Size <br /> Distance to nearest: Well --------------------------------------- <br /> _Foundation .................... Prop. Line ----_----.-----_---.._ <br /> "REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I <br /> Septic Tank (Specify Requirements) ............:. `= = Via..... -----------------•-------:.- ...-•--...------........_----................ <br /> Disposal Field <br /> /y(Sppecify RRe`quiremeentys)yam..-���_-f--�-....'f:a..---.�_�+�---..�'�G�j��'�-�j�---1"7--------------- <br /> </.[........�.-.-----•-•-------------r---i'-�';--•-�--��-........................:----............---....---._.............--.._.--...--. <br /> .........................................•--.............-..-..-......-... •-:. <br /> - ------'---•--•---------------------------�-`----------•-----._. ...---._...._.--.....-----.-._.-.---------------------. <br /> ' (Draw existing and'required'addition on reverse sidej�' <br /> 1 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 liven- <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 I <br /> as to become subject to Workman's Compensation laws of California." l <br /> Signed ...................... ?' w�j <br /> ---... <br /> ... �.. <br /> Owner <br /> Title <br /> .-...By ..................... . 9 . <) � �. . ..... . <br /> (If othenerFOR DEPART ENT USE�ONLY <br /> APPLICATION ACCEPTED BY .. Z .----.. --• DATE ....................�___.._............. <br /> ----------- <br /> BUILDING PERMIT,ISSUED ....DATE <br /> ADDITIONALCOMMENTS --••• ......'......_.....-............................:..................................:........................... <br /> ......- . <br /> .............. ...... • ....... ................. ......... .0 <br /> ...._...-•-•--•...................... . ... _. . . . ............ .... ... <br /> .Final Inspection by GJ 0� 1/ ..... •....-... <br /> .................. Date ......L...................... E <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 13 24 C� <br /> E. H. 1-'68 Rev. 5M 7/72 3 L <br />