Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PIRMIT <br /> {Complete in Permit No. ...... <br /> Ka K �r�r a rz ._Triplicate! ............ <br /> . <br /> ------...............................................-... This Permit Expires 1 Year From Date Issued <br /> Date issued . ... . .7 6 <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 ...%Zf .._. CENSUS TRACT <br /> r-.......... ..........-.........__.. ....---................... <br /> Owner's Name ...---Avx. f. .Y_-e.`t s.Q tee.......--•--•-•--• .................. ......Phone y 7 16 .3..`�......... <br /> Address .._....71- -S•-�----.-•-�.i_.7�A.f .......-_-- -----..--.:Ciry _..�f"qc1[..��?.�.........__................... <br /> Contractor's Name Pa rr s ti....­Y4 <br /> S� S <br /> ........................•_--...............License �•!.?-.S! ..... Phone ..Y.. . _9 6.0.7..... <br /> Instal lation-will-serve-~~~-- —Residence--(al(partment•House fl Commercial oTtaiief do-urt ❑ <br /> -.Mate - . _ — _ <br /> E. Matey❑Other... ..... ................. ........... <br /> Number of living units:_.._ ....... Number of bed ro ms ...Y.......Garbage Grinder ..... kat Size . <br /> ..............:(Ia <br /> fle Ea,Mr� n �,c <br /> Water Supply: Public System and name - <br /> --� .��--------�.:.J.:.s�._..,.....e y.............r�.......,tf.(s.L.ia.c•[:........Private <br /> Character of soil to a depth of 3 feet: Sand 0 Sift I] Clay 8 Peat❑ Sandy Loom ❑ Clay Loam ❑ <br /> Hardpan❑ Adobe arFill Material-...........if yes,type.......•....... ............ <br /> #Plot plan, showing size of lot, location of system in relation to wens,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,l <br /> PACKAGE TREATMENT l ] SEPTIC TANK f ] Size--------------------:............................ Liquid Depth ......................... <br /> Capacity Type .................... Material..................•--• No. Compartments ..................... <br /> Distance. to nearest: Well <br /> `.Foundation ................. Prop. Line <br /> LEACHING LINE [ ] No. of lines ---------- ------------- Length of each line............................. Total length ............................ <br /> D' Box Type-Filter Material .....Dep#h .Filter Material <br /> Distance to nearest: Well -------- ...... ........ Foundation __.._:.................. Property Line <br /> ........................ <br /> SEEPAGE PIT -1 Depth -------------------- Diameter ................. Number _... ......................... Rock Filled Yes ❑ No-O <br /> Water Table Depth ---------------------- --• • -...... Rack Size ................................ <br /> Distance to nearest: Well ....Foundation-- .................. Prop. tine <br /> REPAIR/ADDITION(Prev. Sanitation Permit a# ... Date :--:................. <br /> f ----••. -.... .) <br /> Septic Tank (Specs Requirements) " <br /> t � <br /> qI -._....... �.. ---•--..------•-••.._...--- ..-........ ••-- <br /> Disposal Field (Specify Requirements) ... - -...... r' �_ ...__.i. .: ............... <br /> ........... <br /> -------------------­--------- ...........I.................................... ............ .......... <br /> .7 ---------- ------- ----------------- ................... <br /> ---------- <br /> -----------• •-•----•-.. .----- <br /> ------------ <br /> ----------••- <br /> (Draw existing and required addition on 'reverse side) <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 flutes 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 ermit is Issued, I .shall not employ a„ <br /> p p y y•parson in such mannan <br /> as to become subject to Workman's Compensation laws of California.,' �.. <br /> Signed -------------------------------------------------- Owner ' <br /> BY ....... . <br /> - • -------------------------•-----•--•-•- --- Title 5.. -►..rr c� e� <br /> { iher_than_o-wner)_.�. �. . . � .-.� <br /> OR EPARTMLENT LIST: ONLY <br /> APPLICATION ACCEPTED BY _.. +... - - /.. .. ..z <br /> --- •--• DATE <br /> BUILDING PERMIT ISSUED .............................. y` w DATE -.t.:..-- :._.:.. <br /> ADDITIONALCOMMENTS .. ­---------------- --- --••---------------------•--• ---------------------------•--­.:--•........................ <br /> -------- ----------------•---------._ ---------------- .................:---I------------------------- <br /> • - -•-------- ---------------------------------- ------:-------........................ ..._...-•_..................... ............._...------------•.._-- •- . ------....--....... <br /> ----------------------------------- <br /> -----------------I...... ---------------------- .............. .........---- <br /> Final Inspection b ,.* � .. A- -t---------------------------------------------- <br /> EH <br /> •---------------•EH 13 24 1-68 lieu. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />