Laserfiche WebLink
FOR OFFICE USE: Z1_1 . 6 e - 7 Y,3 <br /> ,APPLICATION FOR SANITATION PERMIT a7sa <br /> -------------------------- -- Permit No. <br /> r (Complete in Triplicate) <br /> ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in,,complpl�ia�nce with'ICount_y Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION d __-- f-X.7.vt4l,--------------------.-----CENSUS TRACT ------- <br /> p qq <br /> Owner's Name --------------------------- -------Phone <br /> Address -------------------------- ------ -- - ----------------- ----------------------------------------. City ---------------------------------- ----------------------------------- <br /> Contractor's Name --------- --------- ----` ---- ---tA:r ------------------------------License# ------------------------- Phone 9(6c7 6W—-- <br /> Installation will serve: Residence ❑Apartment House,0 Commercial :❑Trailer Court ;❑ <br /> Motel ❑ Other --------�---//------------------------------- <br /> Number of living units:___l_----- Number of bedrooms __1�---__Garbage Grinder ----- ------ Lot Size -------- �------------- <br /> Water Supply: Public System and name -----------------t--------------------------------------------------------------------------------------------Private <br /> k i <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> 1 <br /> t Hardpan Adobe i5d 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 if public.-sewer is available within 200 feet,) W <br /> PACKAGE TREATMENT [ SEPTIC TANK:[ ] �A t Size------------ �-------------------- 'Liquid Depth -------------------- /A j <br /> Capacity ------ ---vjylpe A Material------------- ------ No. Compartments -------................ <br /> Distance to nearest:PWe ;--------- .,::Foundation ---------------------- Prop. Line ----------------,------ <br /> LEACHING LINE [ ] No. of Lines ------------�%-_._.-_____- LengthLof each line------__.__....___.-_- .------Total Length -----------_________________ <br /> ` 4 'D' Box ------------ Type Filter Material ----------------0-:Depth Filter Material ---------------------------------------•---- ' <br /> `Distance to nearest: Weir-- ~Foundation ----___ _____ ___---•--- <br /> .___ Property Line ________ <br /> - <br /> SEEPAGE PIT [ beplkh�- i-_____-_0YDiameter-___ __ __ Number -------------------_-------- Rock Filled Yes E] No <br /> Water Table Depth �---,d ------------- Rock Size <br /> Distance to nearest: Well ________________________________________Foundation ___________________ Prop. Line _.------._______-_____ <br /> REPAIR/ADDITION(Prev. Sanitation Permit#g.-------- ---------------- ------ Date ---------------------. ----------- <br /> Septic Tank (Specify Requirements) ----------i------ --------------- -,-�------�--�-------- _---------------,---------------------------- <br /> Disposal Field (Specify Requirements) 1 r"'..' ,��• <br /> l-r <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, 1 shall not employ any person in such manner j <br /> as to become subject to Workman's Compensation-laws-of California." # <br /> Signed ----- ------------- ------------II------- Owner <br /> - --- --------- -- ---=---------------- <br /> I � ' <br /> BY °' = F--------- �7itle - -------- ----- ---- ----- <br /> --- ---------------------------- <br /> (If oth an owner) <br /> . „ ^, . FOR DEPARTMENT USE ONLY <br /> APPLICATION AC EPTED 13Y = -._.- - - --��------------------------------------------------------ - DATE 1 6 <br /> BUILDINGVERMIT, ISSUED -------------------------------------------------------------- - ---- -------------------DATE ------------------------------------------ <br /> ADDITIONALYCOMMENTS': ------ ----------- ------------ ------------------------------------------------------------------------=--------------------------- <br /> -------- --------- ----------""'---------------------------------------------------------------------------------------------------------- ------------------------------ ---------------- <br /> ------------- <br /> -- �"^-f'---\-------------------------------------------- ----------•----- <br /> ------------------------- -------------------------------------------------------------------------------- <br /> ____________________________r-_`. ;_,_,_t _ _ -____ -- --__--__---_-___-----_-,__________________________.__________-___-------_____________ _____ -________ __ _ _ ________ <br /> Final Inspection by- --------- <br /> N--�----------------------------------------------------------------.Date ]. - �cr <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M, <br /> i <br />