Laserfiche WebLink
FORo#OFFICE USE: <br /> =" APPLICATION FOR SANITATION PERMIT <br /> ------- --------------------------------1%3-6 <br /> (Complete in Triplicate) Per No. -. - - �-- <br /> Date Issued-------------------A-M--------------------_-- This Permit Expires i Year From Date Issued <br /> t. - <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 ........Woodward Ferry___(Bacon- -Island._R-o-_ad)-----__-CENSUS TRACT -------------------------- <br /> Owner's Name ---------------------------San__JOaguin--County_------------------------------------------------------Phone.- 9442281 <br /> ------ <br /> Address --------------------- ------------------ 4_-Haze ton--AYe=----------------- City -------S_tackt-on,---ca,--------------------------.......... <br /> Contractor's Name -----------------------P-arr.isYL--Inc•----------------------------------License # -----x.00511--- Phone _4663$31--------- � <br /> Installation will serve: Residence ❑ Apartment Hou es 0 Commercial:❑Trailer Court ❑ <br /> Motel ❑Other ----------------=------------ <br /> Number of living units:-.0rle.- Number of bedrooms ._9J1e__Garbage Grinder -.SIS]____- Lot Size --- 500 _Sj--------------_---- <br /> - _WatWater <br /> er Supply: Public System and name -------------- No----------------------------------------------------=-----------------------------------Private:K] 1 <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ PeatMc Sandy Loam ❑ Clay Loam .M <br /> } <br /> Hardpan ❑ Adobe ❑ 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.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 0 <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth -------------------------- 0 <br /> Capacity -------------------- Type -------------------- Material---------------------- No. Compartments -- ................. <br /> Distance to nearest: Well ---`--------------------------------Foundation ---------------------- Prop. Line ---------------,-....- <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length <br /> ------------ -- <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------------------------.-. .. <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number -------------------------- - Rock Filled Yes 0 No 0 t <br /> Water Table Depth ---------------------------------------=--------Rock Size ---------- --------------------- I <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --------..._-------. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- <br /> Septic <br /> ---------------------------------Se tic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) _80t--Rep111ce---existing--drai-n------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------- ------------------ <br /> - <br /> ----------------- <br /> (Draw existing and required addition on reverse side) <br /> I 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 --- - 4r Ish---encOwner <br /> - <br /> BY -`-"-------- --------------- Title Pr`a' t <br /> (If other than owned <br /> FOR PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--,-- ------ - -- ----- / ---- ----------------. DATE ------ ��__ ------------- <br /> BUILDING PERMIT ISSUED ------ --------------------------------------- --------------------------DATE . ---- ------------------ <br /> ADDITIONAL COMMENTS <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------- <br /> ----------------------------------------------------------------------------- ----- <br /> -------------------------------------------------------------------------------------------&LOL <br /> ----------- <br /> Fina Inspection by: -------------- -- ---- ---------- -----------------------Data <br /> SAN JOAQUIN HEALTH DISTRICT W <br /> E. H. 9 1-'68 Rev. 5M <br />