Laserfiche WebLink
t FOR OFFICE USE: > <br /> APPLICATION FOR SANITATION PERMIT 77 <br /> ............... PermitfNo./..3.`/ � <br /> (Complete in Triplicate) . <br />...................................................... .. - <br /> This Permit Expires 1 Year From Date Issued Date IssuecYV.:f/—. <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 ADDRESSJLOCATiO <br /> ....... G_-Ir. .... V! ......... ...........................................CENSUS TRACT ......_.._._. .......... <br /> Owner's Name ' t _.�� 1 <br /> 3.± � lll _....Phone .. <br /> Address ............. .t .. _ .. .... . Ir .. r6� :- City ....�- 2 ?'t... .. ... _ . <br /> Contractor's Name ...... Q":.. ;c.� .._.License # .........................Phone'.. <br /> Installation will serve: Residence Apartment House 0 Commercial oTroller Court 0 <br /> Motel ❑Other .................................. <br /> Number of living`:u`nits:.._.1--.___ Number of bedrooms ...--•.Garbage Grinder .. I?0 Lot Size ._._._. <br /> Water Supply: Public System and name ------------------------ .............--------------------_...........------._........ •-• Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silt E] Clay 0 Peat E] Sandy loam 0 Clay loam ❑ <br /> Hardpan ❑ Adobe 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 Ifpublicsewer ii��sffovail 6191ciuld <br /> ithin 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size..1._._ .__. ..__R-l!._._ _..._ _ <br /> uCY <br /> Depth ........................•. J <br /> Capacity --- - _-- Type .....Ll.............. Material No.No. Fomportments ...:�... <br /> Distance to nearest: Well ....... .. .............FoundatiionI-----�./.....-.----- Prop. Line ... .4---- .-.--. <br /> LEACHING LINE [ ] No. of Lines ......--•-___-____-- Length of each line,-t_ - _. Total Leng#h ..�, +� .................: ' <br /> D' Box __ Typo Filter Material Depth Filter Materia <br /> 0 Cl 51191;......------ <br /> ;&U� l. ... .. .............. <br /> t <br /> Distance to nearest: Well ... .--_-__--.. Foundation . . ....... -- -•-_..... Property Line 3'....:?`=_......---fn i <br /> SEEPAGE PIT [ ) Depth ._......._ -------- Diameter ................ Number _......-------.--..__.---.-- Rock Filled Yes ❑ No ❑ <br /> Water Table Depth ...................Rock Size <br /> I <br /> Distance to nearest: Well ..................•-.-----._...........Foundation ..................... Prop._Line ........__... ........C <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _._................................:........ Dote .................................. C <br />- " Septic Tank (Specify Requirements) ................................................................. ................... t <br /> Disposal Field {Specify Requirements) ...............................•-----•....... <br /> ------...•....................•--...----------------.....------ ............ <br /> f r <br /> ---­--------- ._ <br /> (Draw existing and required addition on reverse side) ;t'1 <br /> 1 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: 4 <br /> "1 certify that in the performanceofthe work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to becom subi t to Workm Ft's Compensatiotii"laws of California." <br /> Signed . .. L - -------------••- Owner <br /> (� : Title ......... Ari <br /> By ..............................................................:.........•----- -•.....---._....••--- <br /> lif other than owner) <br /> _ FOR DEPARTMENT USE ONLY 2 Jy <br /> APPLICATION ACCE ED 8Y ................ .... .. •. •----- DATE A? ":?r.`-7.•�................� <br /> ,, <br /> L ING PERMIT ISSUED ................................. -----------•.... .:... .:.. DATE ............. ................. <br /> ..r1 <br /> ADDITIONALCOMMENTS ..........-•.............................•-........._ ........---- ........... :................ i <br /> .............---.......................------.....................---..............._.................................................................._..-•---------------.................----....----• <br /> ....•..--•.......................••. ... _.. .......-.......:....--------------- • ---.--------------•-----._..:...................................... ....... . <br /> Final Inspection by: ....:.. .... .... :..-. <br /> -•---•................................................Date . . �._ .' 7.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT e <br /> J <br /> E. H.13 24 1.•68 Rev.-5M •. 7172 1.0 <br />