Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ----------; -------------- ---- ---- ------ ,. <br /> (Complete in Triplicate) Permit No. <br /> ------------------A -- <br /> Date Issued z"_Z3`7 L <br /> -_- ------------1-- -- This Permit Expires 1 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 f <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: k <br /> JOB ADDRESS/LOCATION .--RJ-----n------,----- -------------------------.-----CENSUS TRACT ------------------•-___--- <br /> Owner's Name -_,�1----.E 1J1 ------------------------------------------------------------------------ -------------------Phone'/j -- 75'37/7---- <br /> Address --- per 1L�_411� Q� ----------------- ------------ City ._.SZ���C`1 'll1/------------------------------------- <br /> �'� _ License #� -�-------- Phone y-�—__ —21K____.. <br /> Contractor's Name .E�----'.�.�--�a�---ySFh-a------------------------------- -- ---- <br /> Installation will serve: Residence Apartment House[] Commercial :❑Trailer Court ;❑ <br /> Motel ❑ Other ------------------------------------------- <br /> Number of living units:--/-------- Number of bedrooms --3------Garbage Grinder Lot Size /0j0-;11�`­/..�-V---------------------- <br /> Water Supply: Public System and name --------------------------------•--•---------------------------------------------------------------------------Private ❑ .I <br /> Character of soil to a depth of 3 feet: Sand❑ Silt E] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe❑ Fill Material ------------ If yes, type _________-________------ <br /> Y� 1 <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 3 <br /> NEW INSTALLATION- {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ` <br /> PACKAGE TREATMENT [ SEPTIC TANK?K ------------ ---------- Liquid Depth __ ..................... <br /> Capacity 1 Typ6 .f14 MaterialC_' Z� No. Compartments r .................. <br /> Distance to nearest: Well -- - "TT ________________Foundation _le9-------------- Prop, Line ______-___________ `S <br /> LEACHING LINE No. of Lines �% <br /> ( 1 __:,.2______________ Length of each line-____.'-__ Total Length <br /> D' Box }� --- <br /> Type Filter Material QC' ------Depth Filter Material __��___ _ __ <br /> // <br /> Distance to nearest: Well-------- ------- Foundation ./__D__'_______________ Property Line -.-._.....__-_____ <br /> SEEPAG PIT f ] Depth _-AQ------------ Diameter ---------------- Number _____ — Rock Filled Yes ❑ No ,0 <br /> � 17< Water Table Depth ------------------------------------------------Rock Size --------------------------- ---- --, , <br /> Distance to nearest: Well__________________-______________________Foundation,:`:____________-_ <br /> . -- Prop. Line .....__.------•-_-••-- <br /> REPAIR/ADDITION(Prey. Sanitation Permit# --------_---------_------------------------- Date ----------------------------------11 <br /> i <br /> r <br /> Septic Tank (Specify Requirements) --------------------------------------------------------- =_;------------=-----'-----------------------------...--------------•----------•- r� <br /> f <br /> 3 - <br /> Disposal Field (Specify Requirements) ---------------- - ---- -- ---------------------------------------------------------------------------------------- � <br /> w <br /> __________________________________________ _.-'f_____-_____-__---_--______-___-v________________________ <br /> es <br /> [Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and thai'the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son 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 or//ma ' om ensation laws of California. ' <br /> Signed ------------------------• -- t----------------------------------- Owner i <br /> BY Title(If of er tha o <br /> FOR DEPARTMENT USE ONLY i <br /> APPLICATION ACCEPTED BY - r ------------ DATE.Z-ZZ� -7ZZ----------- <br /> ------------PERMIT ISSUED ------------- ----- -- DATE ------------------------------------------. I <br /> ADDITIONAL COMMENTS -------- <br /> ----------------------------------------------------� -�--- ---- -- `--- -- ---- - - - - ----�^" ---- -------------------- <br /> --------------------- <br /> ---------------------------------------------------------------------------------------------- ---------------------------- --------- ------------------------------------------------------------------- <br /> ------------------------------- ------------- ' <br /> Final Inspection by: ------------ = ------------------------ ----------.Date <br /> SAN JOAQUI LOCAL HEALTH DISTRICT 6)) <br /> E. H. 9 1-'68 Rev. 5M <br />