Laserfiche WebLink
t <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT t <br /> ' rt Permit No. <br /> ... .��.�.�•:�•••• � <br />........... ........................................... r•. _ <br /> (Complete in Triplicate) <br /> ............ ......• Date Issued <br /> This Permit Expires t Year from Date Issued <br /> A lication is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein <br /> described. this tion is ma n com me with County } <br /> pp Ordinance No: 549 and existing Rules and Regulations: <br /> i <br /> JOB ADDRfSS/LOCATIONJ� A <br /> A/..... ' .....CEN5U5 TRACT .......................... f <br /> �} ........... one ... ` <br /> Owner's Name _ t1. .... . . ...... ............................ .......... m / ,r . .......• # <br /> ........_... City cam... %•-y.. <br /> Address ....... .7. � I <br /> Contractor's Name --- ... . .L .._.-:-T -..e........lye..................License +1 ��' ? ... Phoria ................... <br /> installation will serve: Residence Q"A' partment House 0 Commercial[]Trailer Court ❑ <br /> Motel p Other.............................................. <br /> Number of living units ----�F- <br /> : ..... Number of bedrooms ...,A...Garbage Grinder ............ Lot Size .....��r�%t�� —.. , r <br /> Water Supply: Public System and name .... -------------_-_-------- _.._....---•.......................................:.................... .Private fz�-` <br /> Character of soil to a depth of 3 feet: Sand❑ Silt Q clay Q, Peat p Sandy Loam 0 Clay Loam I] <br /> Hardpan[' Adobe Fitt Motorial _........... !#yea,type.....:......... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.l <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if ppublic.,sewerZ¢civaiiable within 200 feet,l � <br /> PACKAGE TREATMENT [ SEPTIC TANKI�'J/ Sice#/ �.i'._ ..�Y_ .f..... ------- Liquid Depth ...!,/................- <br /> Co ci ,...... Type "? - hAateria! ><!'L N6. Compartments ... ... ..... . <br /> Distance.to Rnearest: Well '+''• ` ............_ gvndati-ran --../ ? Prop. Line .. ...... <br /> LEACHING LINE No. of Lines .......a---------•--• Length of each line-•••-...F�?./.'r...... Total Length k-r......'`� <br /> ............:...© Bax Type Filter Material ..De Depth Fliter Materlal ..... �-`................. \ <br /> ` <br /> Distance to nearest: Well S� . foundation .....J. <br /> V. Property Litre ......�� .•••:. <br /> SEEPAGE PIT [ ] Depth ........•- ......... Diameter ........... ..:......................... Rock Filled Yes [3 No LCI <br /> Water 'Table depth ...............................................Rack Size.................................. <br /> Distance to nearest: Well -------------------- --- --•-----..:.-Fowndation •----_-----_--.._- Prop. Line ....................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit�# -.... .-•.....-••••{-.-•'-:`.....f..-..----...Date .........,........................I <br /> Septic Tank (Specify Requirements).....'­ f ......_---•-......................................................:. <br /> Disposat Field (Specify Requirements) --=---------------T--- -•----..._.. ....._._...--....-..._....----...-•---- ----._.......:...------..._......--•........ <br /> .F...---•'--•.....................................................................................--_....................--•---......1.. ... ..................................... <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 atone in accordance with San Joaquin <br /> i County Ordinances, State Laws, and Rules.and Regulations of the,San Joaquin Local Health.Distrkt. 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 iss sod, I shall not employ any person In such manner <br /> as to became subject to Workman's Compensation laws of C01fornia." <br /> Signed - ------------------------- Owner V <br /> Title -.�-L.l -e,I,.1 -'• <br /> ----- <br /> 8y (If other than owner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .___..._ ----C.,. _ ........: DATE ..... .7:7. ..•-' <br /> BUILDING PERMIT ISSUED -------------- ------ DATE ..... .................................... - <br /> ADDITIONAL COMMENTS ------- _4 s-W A, .-- - y� <br /> --------------- "--•- <br /> ....__....-'--'...............•--•--------------..._....--•-------------------- ----_----------------- -------------..........__-----------...................... <br /> --------------------- ----- <br /> .......... <br /> Final Inspection b ����... <br /> - ._Date ................................... <br /> EH 13 2!t 1-68 &v. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />