Laserfiche WebLink
FOR OFFICE USE: w <br /> APPLICATION FOR'SANITATION PERMIT <br /> (Complete in Triplicate) <br /> Permit No. .7,3-...� __. <br /> This Permit Expires 1 Year From Date Issued Date Issued .A Y: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. 544 and existing Rules and Regulations: <br /> s, <br /> JOB ADDRESS/LOCATION ... ..............................................CENSUS TRACT .......................... <br /> Owner's Name .....C?1G? .,( '._=, �.< �� �tE' .--_-----•--_--- ....................... --Phone .................................... <br /> Address -.. 7�',�'� `... - ......................... .......... City ...............................................Contractor's Name _. ......;r~; ;V- 11; ..........-----------------------------License PhoneA�����f ��.. <br /> Installation will serve: ResidenceA Apartment House C❑ Commercial LoTraller Court ❑ <br /> Motel E]Other __.....-----`-•-•--•----._................. <br /> i <br /> Number of living units:.--/_... Number of//b'edro/oms _.;Z -....Garrbba'ge Grinder -. Lot Size . ,ft p.............. <br /> Water Supply: Public System and name ..._Lr.� /`'.....41W ..... .-------------------------------------........Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy.loam ❑ Clay Loam 0 <br /> Hardpan ❑ ' Adobe Fill Material _...___.._ If yes,type .......................•_-•- <br /> (Plot pian, 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 avai166le within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK —� ae7ZZ .,?_�.��.__ _... ........ Liquid Depth . <br /> ... <br /> ty <br /> Capacity/ .__..- Type__,� Material ,fid._..... No, Compartments .2.�............. N <br /> Distance to nearest: Well ��� .....Foundation �ef.......... Prop. Line .t ` W <br /> LEACHING LINE [ ] No. of Lines -----.._-------------- Length of each line............................. Total Length _............ .............. <br /> 'D' Box Type Filter Material .Depth Filter Material <br /> }x Distance to nearest: Well ........................ Foundation ...._... ............... Property Lime ........................ Y <br /> SEEPAGE PIT [ 1 Depth _----_---_---_-. Diameter ................ Number ............................ Rock Filled Yes ❑ No <br /> Water Table Depth -------- ..............._.......................Rock Size ................................ 7+ <br /> Distance to nearest: Well ------------•-•.........................Foundation ----------- ........ Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sar itotion Permit# ...... ......................................... Date .............................. ....... <br /> Septic Tank (Specify",RegUirements) <br /> DisposalField (Specify Requirements) --........................................................................................................• ......................... <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 ------------------- ..... Owner <br /> ,�. <br /> A <br /> ........._. z ........................ <br /> (if er than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... ----------------------------•--•--------------------------------•........ <br /> .... DATE ......� �.. �.... <br /> ............... <br /> BUILDINGPERMIT ISSUED ........ ...................._........... -••-•-------•-•-•-•.--••-......_....---• .......--•.._............DATE ........................................... <br /> ADDITIONALCOMMENTS ............................ •--------..............----............•-•-- ----..._......•....-- ,..................._._... = <br /> --------------......---••..........................................=........-............................... ---•-- ._.......-. <br /> -----...................... <br /> ...........Final Inspection by: ... ..... ........ Date .C?-:. .`- ----...---_.---• <br /> ......... <br /> _ ..., SAN..JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 13 241•'68 Rev. 5M 7172 3A <br />