Laserfiche WebLink
01 <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------- Permit No. 73_��� <br /> (Complete'in Triplicate) <br /> ------- <br /> ---------- ---- <br /> 1 r Date Issued 'r�._-_------------- <br /> ---------------- <br /> -_ _ -!__-!-___-_______________ This Permit Expires 1 Year From Date Issued <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/LOC TION / �``` 2 `-__� ,-,1��'� �f f!'ONSUS TRACT <br /> f .� `� <br /> igct <br /> OwnersName --- . ��£ 9 �� ------------------------•-----------------------------------= ----------- Phone <br /> Address ------ - -- ------ -----------------------. Cit -------------------------------------------------------..------ <br /> Contractor's N me ------- � - - ------------------------------------------License _ 5� , " . G <br /> -�;V ��_ Phone <br /> Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court i❑ <br /> Motel ❑ Other-------------------------------------------- - <br /> Number of living units:----- Number of b roo s �. arre Grinder - __�_�__ Lot Size - ___ _..___ <br /> Water Supply: Public System and name ------- '- _ <br /> Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt Clay eat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Material T, __ 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,) / <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ,,ze_._,�C_ 5� ---------- - --- Liquid DepthlZ_____________ <br /> Capacity Type2-_C.I� Material( No. Compartments _ <br /> Distance to nearest: Well ___e�1„ __________________Foundation -__/40_.1_____._ Prop. Line ------------ <br /> LEACHING LINE [ No. of Lines .Q,�-___________ Length of a ch line____f{ _ ___ Total Length _ ____.___ <br /> Qr <br /> D' Box _ ,,__ Type Filter Material _ __ ____ .__Depth Filter Material __- ________________________________ <br /> Distance o nearest: Well _ r4_______ Foundation ___ --- Property Line .............. <br /> SEEPAGE PIT [r] Depth _ ',______ Diameter/0_3_1__ Number __ __ _________________ Rock Filled Yes No i❑ <br /> Water Table 'Depth ____-- ----------------------- <br /> _______________________Rock Size __ ,1�11`_ _______ <br /> _T__ .- <br /> Distance to nearest: Well ___-_ '�-----------------------Foundation fJ_l__'�_-___- Prop. Lines.�.............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _____________________ ____________________ Date ---------------------------------- <br /> SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------•-----------------•---------- <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------ ------------ <br /> k. <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 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, 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 /> ---------------- ---- - <br /> Title -__ ____ _ <br /> (If other th owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -----C- -------------- ------------ ----- - <br /> --------------. DATE - -7 - _ <br /> -- --6 '_i'--------------- <br /> BUILDING PERMIT ISSUED ------------------------------ -------------------- ------------------------------ - DATE <br /> ADDITIONAL COMMENTS ----------- - - <br /> ------i <br /> b r13 - <br /> ----------------------------------------------- --- <br /> FinalInspection by: -------------------•-------------------•---------------------------------------Date --- ----------'------'13- ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />