Laserfiche WebLink
FOR-OFF?CE USE: <br /> +:. APPLICATION FOR SANITATION PERMIT <br /> V1 <br /> Permit No. -� ----------- <br /> --------------------------------------------- 3 <br /> ------ (Complete"I Triplicate) 3 <br /> ---------- p <br /> [..�`� 3`�� Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> ---------------------- <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 .. �ll � �1X� -----------------------------------------------------CENSUS TRACT - M <br /> Owner's Name Phone <br /> %�_u.-lr i/U 1-�k.H-S------ e t--------------------------- - - ----- <br /> Address --X-2------- l i i�f!_t -- <br /> P� K..�ry/�f e----- a 1- ------- l <br /> Contractor's Name ------ow It--� / -----------License # Phone ----- l <br /> Installation will serve: Residence ❑ Apartment House,❑ Commercial :❑Trailer C urt i0 6 <br /> - MotelOther -------���� <br /> Number of living units.---c.-5� Number of bedrooms _- __-_-Garbage Grinder NO--- Lot Size ---- <br /> El <br /> Water Supply: Public System and name ---------------------------------------------- -------------------•------------------------------------ Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat Sandy Loam -❑ Clay Loamry❑ <br /> Hardpan F-1 Ado be`❑ `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 reverseIsi.de.).NEW INSTALLATI <br /> ON: (No septic tank or seepage pit permitted. if public sewer�iavailable within 200 feet,) tt//SEPTIC TANK Size�_�- ��OQ __-"�`' Liquid Depth -----_412PACKAGE TREATMENT [ ] ° +rL.(�Capacity -5�ta .2fTYPe `_- --- er'a I----------- No. Compartmentsi <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -------- ------------- <br /> LEACHING LINE 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 Depth --- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No I❑ <br /> Water Table Depth --------------- ---------------- <br /> --------------Rock Size ----------------------.--------- <br /> - <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -•-------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 <br /> �_- ?-Q p° ` --------16-��---�---ice--------------- <br /> Septic Tank {Specify Requirements} __ - _ --- - --�.�-- - <br /> - � fJ _ --------- --------------- <br /> Disposal Field (Specify Requirements) ---•r�D---------P_�P�---- ---� =--��`-.-- - - ------- ------------------ -------- <br /> ------------------------------------------------ <br /> ----------------- <br /> ------------------------------ <br /> --- ----------------- --------------------- <br />_ (Draw existing a req red 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 ---= . .fe-0145 ------------------------ Owner <br /> -------------------- Title ------------------- -------------- ------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> I APPLICATION ACCEPTED B �..Q1...-�_.�. -- :. �-��-------•---` ------------------------------------------. DATE _ - y�1'� ------------------- <br /> BUILDING PERMIT ISSUED ----------- ----- - ------ ------------------------------- D TE ---------- <br /> ADDITIONAL COMMENTS ..- - -1 -7` J �6---�-- � 1 U_- :- x G+�--,2�( 3zf = ' <br /> ------------------ ----------------------------------- ---------------------------------------------- <br /> ------------------- ------- ----------------------------------------------- ----------------------- <br /> -----------------------------------------------------------------------------------------------------------=---------------------------------------------- <br /> ---- ------------�'__----_ __ --i- w -- _ --- - _-____--_.__--- <br /> - <br /> = -------------- -- . .r`--------- <br /> ------- Date -- -- -------- ----- ---- <br /> Final Inspection by <br /> SAN JOAQUIN LOCAL, 'EALTH DISTRICT <br /> E:`H. 9 1-'68 Rev. 5M <br />