Laserfiche WebLink
FOR OFFICE 0USE: <br /> !CATION ICOR SAWAYM Wff <br /> ►�/ Permit No. �? f� <br /> t in Triplicate) .. <br /> .................................................... This Permit Expires 1 Yew From Daft Wood Date issued ..S.t7.2:2, , <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 mode in compliance with County Ordinance, No. 544 and existing Rules and Regulations <br /> JOB ADDRESS/LOCATION.. _dP ._. .. ...... ..............................CENSUS TRACT .......................... <br /> Owner's Name ..l!f . .. .... .. ... .... ........ ..................................... <br /> .............._................ <br /> .....phone ............. ...................... <br /> Address -----..��'4.'----•-"5%-----tia . .....................................................City .14A. 9 <br /> ........._ <br /> Contractor's Name /,�2� .---------------•----------......------...------.....................License# ........................ Phone .............................. <br /> Installation will serve: Residence❑Apartment House l❑ Commercial❑Trailer Court <br /> Motel❑Other............................................ <br /> Number of living units------------- Number of bedrooms ............Garbage Grinder ............ Lot Size ............................................ <br /> Water Supply: Public System and name .................................................................._.......... .. ❑ <br /> .......................Private <br /> Character of soil to a depth of 3 feet: Sand f] Silt f3 Clay ❑ Peat❑ Sandy Loom Q Clay Loam <br /> Hardpan p Adobe 0 Fill Materlal............if yes,type........................... <br /> (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATIONz (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) YYY <br /> PACKAGE TREATMENT f ] SEPTIC'TANK f j Size------------------------------------------------ Liquid Depth ..................... <br /> Capacity .................... Type ---•-•-------•------ Material---------------------- No. Compartments ..................... <br /> Distance to nearest: Well ....................................Foundation ...................... Prop. Line ......................< <br /> LEACHING LINE [ J No. of Lines ---_--_------------- Length of each line............................ Total length ............................ <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ <br /> SEEPAGE PIT f ) Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No <br /> Water Table Depth ................................................Rock Size ....._....... .................. <br /> Distance to nearest- Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .............. ................... Date .................................. <br /> Septic Tank (Specify Requirements) ... .-.��Z -�G�? `e .. ".G � <br /> Disposal Field (Specify Requirements) <br /> --•-------•-•------------------------------------- ..........----.................................................................................................................................... <br /> . <br /> .........--- ................................... ......-............................................................................................ <br /> JDraw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work wifl be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hech k Distrfd. Home owner or elat- <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 became subject tn Workman's Compen atio� Iaws�g California." <br /> Signed �G ....... Owner <br /> r <br /> By -- -------------------------------•-------------------- <br /> *. ........... Title ....... <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _. . .... ... . ...... DATE ................ <br /> BUILDINGPERMIT ISSUED .... .................-..................................................:: ............ _---------_-DATE --- - ............................... <br /> ADDITIONAL COMMENTS .... ........... <br /> ............. ------------------- --------- ..................... ........................................................._..._... ....................................... ......... <br /> ---------- .........----------------......-..............-.......................................................y------....._...... ......... --..... .......... ••...._...... ........ <br /> -------------------- ------------------- ......................................... ...........------------........__.... <br /> FinalInspection by: . .................... ................................................... ,. . .... ........Date ....-�) � �.... ..._.. <br /> EH 13 21i 1-6f3 Nev. 5 i SAN JOAQUiN LOCAL HEA f ISTRiCT 8/7h 3M <br />