Laserfiche WebLink
s <br /> FOR,OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ---- � - ------------•---- ---- Permit No. <br /> -- <br /> (Complete in Triplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> ------_---- --------------_----_-_--- --q_--------.... <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 .-------x5_2A---- ----- ,------ -- , %a--___.__---.-.------CENSUS TRACT -------------------------- <br /> Owner's Name ---------------- ---------- �/ 1 - Phone <br /> } J--------------------------------------- <br /> Address ----------�.-3z-�-J-----L--,- _�f/��---=�---- ------------------•--• City ---- - / <br /> Contractor's Nome -j------ �`" License # --- --------------------------------------- <br /> Contractor's y `` �6/� <br /> Installation will serve: Residence partment House❑ Commercial ❑Trailer Court !❑ <br /> Motel ❑Other -------------------------------------•------ ` <br /> Number of living units:----)----- Number of bedrooms MZ----.-Garbage Grinder/V Lot Size --- ll v <br /> Water Supply: Public System and name ---- LSA .-- ----_---------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Peat 0 Sandy Loam ❑ Clay Loam (] <br /> Hardpan E] Adobe ill Material --11Ja- 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.) {n <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) W <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth --------------------•.••--- tv <br /> Capacity --- ---------------- Type -------------------- Material---------------------- No. Compartments ---------------------- r <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 0 <br /> WaterTable Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -_-----..--------.-. <br /> A <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------S,- Date -----------------.----------------) <br /> Septic Tank (Specify Requirements) ,/� ----------------------------- ---- ------- <br /> Disposal Field { ify Requirements) 1 `� � ` ----�-----/'��-r�,ia2.f� <br /> -- <br /> s <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 become subject to Workman's Compensation laws of California."' <br /> Signed --- --- ---------- -Y------- ------------------------ -- �`-- --------- -=-- Owner q� <br /> BY ---------------- ---- fad - Title ------- --------------------------- <br /> (If other an wner) <br /> FOR DEPARTMENT USE ONLY . <br /> APPLICATION ACCEPTED BY ------ ---------- -- -&Y` --a--V-d------------------------ ------------ DATE --` � �� ------ 71--------- <br /> BUILDINGPERMIT ISSUED ------------------------------------------------ --------------------- ------------------------------DATE ------------------------------------------- <br /> ADDITIONAL CO ME.�1T5 .- <br /> ------------------------ ---------------------------- ----- ---- ----------------- -- - - <br /> ----------------------------------------- ---- � -- ------------------------------------------------------------------- - --- <br /> - - - ------- --------------- ----- <br /> - - ------ -- - <br /> Final Inspection by: ----------------------- ----------------------- -----------------------------Date = --- <br /> N JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />