Laserfiche WebLink
~ " <br />✓✓✓✓✓✓////// FOR OFFICE USk. APPLICATION FOR SANITATION PERMIT <br /> ------------------------- ---------------------- <br /> (Complete in Triplicate) Permit No. --�3-'+�-?•3- <br /> --------------------- <br /> Date Issued <br /> �-`--'a--T-a <br /> _________________________________________________________ This Permit Expires t 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/LOCATION . l"7_'I�0 t�a'�'j11� --------------------- ---------CENSUS TRACT ---------------_------- <br /> / N ev_n/_b-i - - �- sem <br /> Owner's Name --_- _ Phone ---- - ---------------- <br /> Address , City <br /> Contractor's Name --- I/� ---------------------------------------------- License YhP- � le---- Phone <br /> Installation will serve: Residence 9 Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:-__/-___- Number of bedrooms 4------Garbage Grinder ------------ Lot Size _-______--__-----_--------------------- <br /> Water Supply: Public System and name ---------------------- -------------------------------------------------------------------------------------._Private 8 <br /> Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Mpterial ------------ 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 [ I SEPTIC TANK f ] Size------------------------------------------------------------- Liquid Depth -____---__-.--__-_.--_-. <br /> Capacity ------------------ Type -------------------- Material--------------------- No. Compartments ...................... J <br /> Distance to nearest: Well -_/Lengthea <br /> ---------_------.- ----Foundatio -__--__--_-_----_--- Prop. Line ._.__..-____-:------ -` <br /> 7' <br /> LEACHING LINE [ ] No. of Lines ___________________--- h of eac line_-________--- ------------- Total Length ----- ............. O <br /> D' Box ------------ Type Filter al ------- -----------Depth filter Material --------------------.-_-._-_____._-__._:._.. <br /> Distance to nearest: Well ____ _____- _ Foundation --------------- -------- Property Line -----------------..____. <br /> SEEPAGE PIT [ ] Depth --- ---------------- Diamete ___ ______ Number -___.__-________-_____-_- Rock Filled Yes '❑ NoWater Table Depth -------------- --------------------- - ock Size -------------------------------- <br /> Distance to nearest: Well _-_-- ------------------ Foundation ___-__--___--.-_-_ Prop. Line ...--.............._.. �REPAIR/ADDITION(Prey. Sanitation Permit# ------------- ------------- ----- Date ____----_-_----.-..----_--------_.) <br /> SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------------------- -------------------------_--. <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------- ---------- <br /> ----- ----------- -----•------.. <br /> ---------- , --------�o d fi = .......kio �------tea <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, 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 /> j � Title ----------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- --------- DATE ------ <br /> ---- - �?*� <br /> BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------- -- -----------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS --------------------------------- -----------------------------------------------------------------•--------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- <br /> -------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- <br /> -------------------------------- ---------------------------------------------------•------fir' „ ._ <br /> Final Inspection b ---------------- ----- -------------Date _177— <br /> Final Y: - � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />