Laserfiche WebLink
R OFFICE USE <br /> ......... ......... <br /> APPLICATION FOR SANITATION PERMIT <br /> ". Permit No <br /> (Complete In Triplicate) <br /> .................I This Permit Expires 1 YeFrom#late Issued <br /> Date Issued <br /> ar ....... ....... <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 .._. ..... 1. a ////......... r.-.. .. . .. .........CENSUS TRACT .......................... <br /> Owner's NameY-.. <br /> -..................................... ....................Phone .................................... <br /> Address ........� _..1........ .r.. `."/o:-............................. City. ' , `"-..,...................................... <br /> Contractor's Name _. d �,-�a� � ..�_.� f {Sl..,,dco ....license <br /> Installation will serve: Residence Apartment House fl Commercial OTrailer Court 0 <br /> Motel❑Other............................................ <br /> QJ* <br /> Number of living units:.....42-.. Number of bedroom -� .Garbage Grinder . -�''.. Lot Size ..,� 67:..X. . ...... <br /> Water Supply: Public System and ®� ' _ ,.�--_...................-. ... <br /> y name ..---�- - -- -'--C.,.�......(,,s..L•�-L�[!�'. .- .. .Private(] <br /> _ _ a <br /> Character of;soil to a depth of 3 feet: Sand❑ Silt Q Clay ❑ Peat Q Sandy Loam 0 Clay Loam 0 <br /> Hardpan[] Adobe 0 Fill Mcterial ............ If yes,type.............. ........... <br /> (Plot plan, showing size of lot, location of system in relation to welts, 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,) <br /> PACKAGE TREATMENT SEPTIC TANK .................................................... <br /> .... <br /> ( r � rs�jyz .. _ •....... <br /> _. <br /> �' _.::.-•-•----•- ..:.......... Liquid- Depth ........................... <br /> Capacity ----- ......... Type .................... Material---------- •---------- No. Compartments ...................... <br /> Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE X No. of Lines ......A............ Length of each fine......lee ... Total length ........ iJ <br /> 'D' Box ............ Type Filter Material ...........Depth Filter Material <br /> Distance to nearest: Well .O':Lsr Foundation .le............... Property Line .-5..... ..... � <br /> SEEPAGE PIT ( I' Depth .................... Diameter ............ .. Number ............................ Rock Filled Yes-[1- No 0 <br /> WaterTable Depth ................................................Rock Size ................................ _ <br /> Distance to nearest: Well <br /> ........................................Foundation .................... Prop. Line....................... <br /> REPAIR/ADDITION(Prev. SanitationPermit# ............................................ Date ................................ 9 <br /> Septic Tank (Specify Requirements) ........... .............. .......... ........................................---... .....4—.1............................ <br /> Disposal Field (Specify Requirements) •-•"-•".-"....•......"-"-"---.....--".... ..............•--"-""...............-"-"----•-""-""-----...........................•.......,t <br /> .�-._. 0 <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, Sta» Laws, and Rules and Regulations if the San Joaquin Local Health District. None owner or Ueen- <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 /> By .._. L -�...._ . . ci.............................. <br /> (if other than owner <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. ... . .... ... . ........ ....... <br /> ... ... ------------------------ DATE � ---------_ <br /> BUILDING PERMIT ISSUED ..... ... 3 <br /> -_DATE .........................)�-----.-------- <br /> ADDITIONAL COMMENTS ................ ....... <br /> - - - -----"------------------......................................................................... <br /> ..............._.................. <br /> ..................•-•----- .._... ....................••---.... <br /> Final Inspection by: ...-- ---- -- - - . ..----------------------------------------------- .----------- --- -...------•--•Hate ...._.];.:.5.........�,F,.l..-- .. ...-- <br /> EH 13 2!t 1-+68 �!! SA JOAQUIN LOCAL HEALTH DISTRICT 8/7h <br />