Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / <br /> Permit Na. <br /> (Complete in Triplicate) <br /> -----=-------------------------------- Date Issued -�/ -�� <br /> This Permit Expires 1 Year From Date Issued -7 <br /> (-7 y,Z <br /> YW- j vo 7 <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 /> 2ZB� ? N. E.Lt—,i 0 77—" <br /> ,� CENSUS TRACT _ `�-- - ------------ <br /> JOB ADDRESS/LOCATION .-_�- -�' ,- '�`----- --- <br /> Owner's Name -------& ------- ls'`-': ---------- ------------------- ------------ ------------ Phone d c�� <br /> ------------- <br /> Address ---------- --sP_+ ------- ------------------------------ - City / fn -----------------------------------... <br /> Contractor's Name ------ ---------------•License # ---------- ------------- Phone -------------------------_--- <br /> Installation will serve. Residence )'Apartment House❑ Commercial ❑Trailer Court i❑ <br /> Motel ❑ Other ------------------------------ ----------- <br /> Number of living units-------1----- Number of bedrooms ln-------Garbage Grinder ------------ Lot Size -------------------------- <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 /> Adobe'❑ Fill Mafierial ---- _----_ If yes,typ <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 f ] Size------------------------------------------------ Liquid Depth ------------------------- <br /> Capacity ------------------- <br /> ----------• --Ca acit _ Type -------------------- Material---------------------- No. Compartments -----------.-.--.:-.-- <br /> Distance to nearest: Well ------------- ----------•-------Foundation ---------------------- Prop. Line ---------_--=-------- I <br /> LEACHING LINT; [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length _--------------------------- <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------•-----------•-----------•----•..-_._ O <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ---.----_-----•------- <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 <br /> WaterTable Depth ------------------------------------------------Rock Size ---------------------------- <br /> Distance to nearest: Well --------------------- ------------------Foundation -------------------- Prop. Line ..-.-_---------.-••--- et <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) 7 <br /> Septic Tank (Specify Requirements) -------------- ---------- ------------------------------------------------------ ------------------------ fl' <br /> Disposal Field (Specify Requirements) ---- ----- lr� �," -- - <br /> - ----------------------- -- - <br /> ,: a <br /> --------- - -- <br /> ----------------- <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 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 bec e�subject to Workman's C(Lmpensation laws of California." <br /> Signed'`' Owner <br /> ----------- Title -- --------------------------------------------------------------------- <br /> (if other than owner) <br /> ` FOR .DEPARTMENT USE ONLY <br /> -.- ` - A f <br /> _,� fir' - DAT <br /> E -�` -~ - <br /> APPLICATION ACCEPTED BY <br /> BUILDING PERMIT ISSUED ------------------- ------ - -------DATE ------------------------------------------- <br /> -- ---------------------------------------------------------------- <br /> ADDITIONAL COMMENTS ------------------------------ --------------------- <br /> Ar <br /> ---------------------------------------- <br /> -------- --------------------------------- ------------- -- ----------- .< <br /> Final Inspection b - - - ----_---.Date '-«---- -------- - -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M• <br />