Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATW*i-MR SANITATION PERMIT <br /> ----------- �j,,-� t --------------------- (Complete in Triplicate) Permit No. <br /> -�° ---d--- ------ -- --- -- ----------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued 5�——- <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 _ R_ _ _ —In 4L�------.----.CENSUS TRACT __.___________________ <br /> Owner's Name __ U) c?----3_ ---------------------- ----------------------- - -------------------Phone - 3J_'_ _I CQ---------- <br /> Address -------------------�1?0--- _ Q� --•--. City _ A---------------------------------------------------------- <br /> Contractor's Name ----------------.OUA� I k..---------------------------------------------License # --- ---------- Phone ------- <br /> Installation will serve: Residence M-Kpartment House❑ Commercial ❑Trailer Court !❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:____ ____ Number of bedrooms --- .....Garbage Grinder -___ __- Lot Size ------- 14-_,_____-_-_______________ <br /> Water Supply: Public System and name ----------------------------------------------------------------------•---------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe X 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.) v <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ SEPTIC TANKI Size----- ____ ____________'__'_.___e_____.___._ Liquid Depth -----sS3-_4�)_...._.......... <br /> Capacity ! � -_-._ Type _ .... Material___ No. Compartments <br /> Distance to nearest: Well ____ 0-----------------------Foundation -----/Q---------- Prop. Line --- .. <br /> LEACHING LINE V4---No. of Lines .--_- 3------------- Length of each line___-__$'C�-, g .....................`'�b <br /> Total Len th <br /> 'D' Box Ve-5---- Type Filter Material _59P -_---Depth Filter Material -----l <br /> Distance to nearest: Well --------- Foundation -----00- ______- Property Line ___-c................ <br /> SEEPAGE PIT [ ] Depth ___________________ Diameter _______________ Number ---------------------------- Rock Filled Yes '❑ No 0 <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well __-------------------------------------Foundation -------------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) <br /> SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- -------------------- --------- -------------------------- <br /> Disposal Field (Specify Requirements) _________-__ ______________________________________ <br /> ---------------------------------------------------------------------------------------- <br /> N <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 certifWthal the performance of the work forwhich this permit is issued, I shall not employ any person in such manner <br /> as to bbjb mpensation aws of California." <br /> Signed - ----------------------------------- Owner <br /> BY ------------------------------------------------------------- -------------------------------------- Title ------ ---------------- ----------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT LY <br /> APPLICATION ACCEPTED BY --------- -------------------- ------ DATE _--f------------------ <br /> BUILDING <br /> ----------- <br /> BUILDING PERMIT ISSUED -------------------------- --------------- DAT ------------ ----------------------------- <br /> ADDITIONAL COMMENTS _ - -------------------- --------•------------------ <br /> -- ---- ---------------------------------- -------------------------------------------------------------------------- -------------------------- - ----------------- -- - <br /> --- - ------------------------------------------------------ -- -- - y - -' ------- -- --- -- - - --- <br /> --- - - -------------------------------------------------------------- ----- ----- <br /> r7 -------------- <br /> ------ --------- -Final Inspection by: Date --- --__ _�` -_____ <br /> SAN JOA N AL HEAL H ISS T <br /> E. H. 9 1-'68 Rev. 5M <br />