Laserfiche WebLink
'� OC}R OFFICE USE: <br /> 1� APPLICATION FOR SANITATION PERMIT �_ <br /> ................. - Permit No. <br /> j l[omplete In Triplicate).. ��� �._ 7 �� . <br /> ..................................... Date Issued •6- - 77 <br /> ..... This Perntlt Expires t Year from DoM 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> .IOB ADDRESS/LOCAT N ,.�_'��..��..._.}�.®.... ..W...�tt �:. •..... ... ..........,......CENSUS-TRACT <br /> ..•....................... <br /> Owner's Name •- -................ .. - ..... .. .......... ' ........Phone -..... .. ..................,....... <br /> Address ... .. ��f� F ........... City .... G�' .... . - <br /> Contractor's Name J . <br /> .._..-- •- - - .....ls�.�•�.�.�. . ....���:. _ 4..,........License � ..��'� .�.•�-. phone . <br /> Installation will serve: Residence[ ipartment House C) Commercial OTraller Court 0'11 , <br /> Motel Q Other .... ......................... <br /> r <br /> f <br /> Number of living units:....J__... Number of bedrooms .3.......Garbage Grinder ........:.:. Lot Size <br /> Wat- Supply: Public System and'name ..........................................................................................................Private <br /> Character of sail to a depth of 3 feet: Sand❑ Silt Q Clay C] Peat❑ Sandy Loam Q Clay Loam ❑ <br /> .Hardpan Adobe.Q FI11 Materia! --•......... 1f yes,typo ............... ............ . . <br /> (Plot plan, showing size of 'lot, location of system in relation to wells, buildings,'etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No ptic <br /> tank or seepage pit .permitted If public sewer is.availbble within 200.feet,) � <br /> PACKAGE T.REATMEN SEPT,C TANK Size... .. ••• <br /> �f,X.l�•�.....11'__.`�,�y.. Liquid Depth .. ........ <br /> pocity <br /> Co .. _�.Q_o.-_-.. Type _ -.. _. ... Compartments ....................... <br /> :t <br /> Distance to nearest: Well ...___.._)£+.E1. - .........:.Foundation .... Prop.Line _.._......C'........� <br /> LEACHING LINE (,/No. of Lines ---._... __..-..... length of each line---____.!f. -.=.. Total Length ...� ?. ..... <br /> 'D' Bo"x .�:----- Type Filter Material ...... `�s°:._.Depth .Filter Material .. ............ ............. .. rn . <br /> . <br /> Distance to nearest, Well ...... .�?�1. Founda#ion :.�.� Property Line ..:..S1a ..:.. ' <br /> StI:PAGE PIT ( Depth ...._..�r-�Diometer _.„r ?:..... Number ........_ ,:.......... Rock Filled Yes �o ❑ - <br /> :.............. •..:......Rock Size ... :� �1!_,.3��.. <br /> Water Table Depth.- <br /> Distance to nearest Well '.. . . �O Prop. Line 7s v <br /> ----_... Foundation,..... .... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..............- •-••--••••••••• ........ _. Date ... ..:............) D <br /> S�ptic Tank fSgecify Requirements). . --.-.:T_-, ---:....:_...-•--•.................. ......................- --- <br /> Disposal Field (Specify Requirements) .----------f---••-•-`-•----•--...:------;=--•----•.................................................................................... <br /> ...................................... ----. ....... <br /> � I <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 Saes Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health-Distrld. Home owner Of licett- <br /> sedIagents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 14holl not employ any person in such manner <br /> as to became subject o kman's Co easation lavers of California;, <br /> Owner <br /> Signed . ._ ------ - i <br /> By <br /> - <br /> - .......-.... fit#e <br /> lif other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---C-_---------- - - •­__..1­__1_1------------- jDATTIE ,Z . ..72..;---..._....----._... .. <br />` BUILDING' PERMIT ISSUED - ­----------------- -- - -••-•-------- ......................... <br /> .............. •...-.....--------•-._-DATE ....-..-...._._.._.._.._.......... <br /> ADbITIONALCOMMENTS ----------------- _ -------------------------------- .--- ..........._...--•--....... .......-•---------------- . - -------------------­_1---------- <br /> : <br /> --------t <br /> a1 ------------ --•- --- --- ...... .......____ . ._ ...._Y .._._...---•-- ----- .-----------____-__- -•-•-•---•-- .--.....I.----•-........._. <br /> i---------- <br /> Final Inspection b Date . 4 .----- ......-............... <br /> . <br /> EH 13 24 1-68 Rev. 5M S N IOAQUiN LOCAL HEALTH DISIRiCT 8/7h 3M <br />