Laserfiche WebLink
FOROFFICE USE: <br /> y APPLICATION FOR SANITATION PERMIT r <br /> ------ -----------�-•--------------------------------------- (Complete in Triplicate) Permit No. --7-1---2-4-6 i <br /> ------------------ a <br /> " This Permit Expires 1 Year From Date Issued bate issued <br /> - ---------- <br /> p�w -, <br /> Application is hereby made to the San Joa in1_ocal ealth District/for a per to construct and install the work herein <br /> described. T7s�plieatign is ma �n catn )lance with County Ordinance No. 549and existing Rules and Regulations: <br /> �f <br /> JOB ADDRESS/LOC TION . � '` f -- r - --CENSUS TRACT ----------�..------- <br /> . ,. : , <br /> Owner's Name ------------------- ------- - - .._Phone _ ---- <br /> ------��--/�-�� �------ --- ------------- <br /> Address �� g0.� J1.Gv>2 -----. City = ��` "'=: <br /> Contractor's Name -- # _o a1��17=3_ Phone _'� e_-`.� -- <br /> = t s ., ...� .,, <br /> Installation will serve: Residence ❑ Apartment House-Q Commercial wrailer Court ',❑ i <br /> C Y C w <br /> R <br /> Motel ❑ Other --------._----------------------------------- <br /> Number <br /> ____-___ -_Number of living units:___-- Number•of-be ooms ____________Garbage Grinder ------------ Lot Size _.________________________________..___-`'_ + <br /> r <br /> Water Supply: Public System and name ------- --- ----L -----------=---------------------------------------•------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand[] Silt El Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ; Fill Material --_-�_____ If yes,type ____-__-------------------- <br /> (Piot plan, showing size.9f loft, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ] <br /> NEW INSTALLATION:; I {No septic tank or seepage pit permitted if public sewer is available within,200 feet,) <br /> PACKAGE TREATMENT I ] . "SEPTIC TANK' Size__ X_1 <br /> ----------------------- <br /> -------- Liquid Depth __ _ --------- ---- ; <br /> Capacity poU_ Typef c -- Material ------- .No. Compartments --------------..._.-.- <br /> 4 Distance to nearest: Well -------------_.-Foundation __ .'__________ Prop. Line ___�______f...______ vvv <br /> LEACHING LINE No. of Lines -----7__-------------- Length of each line---- _._----- ------ Total Length <br /> � <br /> #. 'D' Box ____ Type Filter Material Depth Filter1 Material ------------------------------- <br /> Distance to nearest: Well --` --------- Foundation __2------------------ Property Line _._.___.___-- -:__" <br /> _107 <br /> SEEPAGE PIT Depth __ ---�Diameter _��__k__-I____ Number ________ ___________---_ Rock Filled Yes' ` No ❑ <br /> ?�, _ <br /> Water Table Depth _____��------�___________________----- ------Rock Size -------------- <br /> � _ <br /> Distance to nearest: Well --- -----------------Foundation - --f-.---- Prop. Line ._ _....____---__.- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------- <br /> Septic <br /> ___-_-______._____----------_.-__Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------------;-------------..__- __------------------ <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------- ------ , <br /> --------------- <br /> ---------------------------------- ----- -------------------------------------------------------------------------------------------------------------------------------------- <br /> Z.... ...�,... (Draw existing and required addition on reverse side) <br /> 1 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 /> { <br /> as to bee �ubj�ectws ofCalifornia." <br /> SignedW man's Com ensation la---------------------- Owner <br /> By -------------------------------- ----- - -- ----- - ---- ------- --------=------------- Title . ----------------------- ------- -------------------------- <br /> (If other than owne <br /> P 1tTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- ------ - -- DATE --- - - --- ----- ---•--------------------------------------- ---------� ---------------- <br /> BUILDINGPERMIT ISSUED ----------- ----- -- - ------ ---------- ----------------------------------------------------- ---DATE ----------------------------i�------------- <br />{ ADDITIONAL COMME -- <br /> ---, <br /> y =�- -- --- - �4J1' yt Prl 41--� �H_y"'.!SSi{J} <br /> m r�/ <br /> i ---------------------------------- -- - -------------------- ----- -- -- -- -------- 7s3. <br /> '�3 k Final Inspection by: -- -- _ _------Date -- ---- ------ <br /> A JOAQUIN LOCAL HEALTH DISTRICT c� <br /> F e C <br /> t <br /> 1 E. H. 9 1-'68 v. 5M <br />