Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
9 <br /> APPLICATION FOR SANITATION PERMIT <br /> mi <br /> FOR OFFICE USE: Pert No. - 17_1'0_15- <br /> e t <br /> (Complete in Triplicate) <br /> : <br /> i` <br /> - <br /> --------- t 1 <br /> -=- --- ------ = Date issued - ! <br /> -------------- This Permit Expires 1 Year From Date Issued , 4 <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is'imade incompliance with County Ordinance No. 549 grid existing Rules and Regulations: <br />' e <br /> ff JOB ADDRESS/LOCATION .J ...... ' D-s. �.ff- ----------- -CENSUS TRACT ------------------------ <br /> Owner's Name - •- <br />! tt''•� , <br /> -1 :� - -- --------Phone --------------------•--------------- <br /> IAddress ------ ---------- 3 -- - ----'=--._ ---------------------------7.r LN------------------------•--• City �----------------------------------------------------------• -•------ <br /> Contractor's Name _ ? --------- -----------------------------------License # _ f� � Phot e Y <br /> Installation Will server Residence. . partment_House'❑`*Commercial ❑Trailer Court ',❑ <br /> Motel ❑Other _ f- ;�,-'1„ ----- <br /> Number of living units----------t._ Number bedrooms __Z____Garbage Grinder es---- Lot Size - ' ------------------------------ <br /> Water <br /> --`---------------------•-- + <br /> �" ------- -------------- --------- --------Private ❑ <br /> Water Supply: Public System and name .___..-_-_ ;_�_._______.___ --- --F---- --- <br /> I <br /> Character of soil to aldepth of 3 feet: Sand'❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam.E] <br />.• Hardpan ❑ Adobe ' rill If yes, type -------------;_..._--_______ <br /> (Plot plan, showing 'size of lot, location of system in relation to wells, building;6fc.- must be placed on reverse side.) V <br /> NEW INSTALLATION:' (No septic tank or seepage pit permitted if public{sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK'{I ize_----31)C1----}G- ------------------�--- Liquid Qepth __7/Z._-__--------__ <br /> , <br /> Capacity _.)_{?-_4 ------ Type �ne _ Material-_ lric c No. Compartments ---Z-............... <br /> Distance to nearest: Well ---------^rI-----------Foundations__/P_(---__---- Prop. Line ---� ...._._._.... <br /> LEACHING LINE f } No. of Lines ----- ----- Len -------- ---------------- <br /> t 'D' Sox ,,,UO- Type Filter Material ___________Depth Filter'Material L__f,--------------------f_.......... <br /> . <br /> / ' <br /> Distance to neare tj Well __.__ -__ Foundation 1�_.-.--1_R°_----- Property Line ._-.--_______________ <br /> 0 ; <br /> S P ept " - - - �6ia et — Number .__/-.-----: __.-}_- Rock Filled Yes Flo i❑ <br /> _ > <br /> ! Water Table Depth -------��----------------------------\_-Rock Size --� " <br /> 51 Distarice to nearest: Well ----------------------------------------Foundation ----- ----- Prop. Line---------------- <br /> t REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------_••------- •----} <br /> { , <br /> Septic Tank (Specify Requirements) --------------------------------------------------------------------------------- -----------..-.._-.,_� <br /> --------------- <br /> Disposal Field (Specify Requirements) --------------------------------------------------------------------------------=----------------- -------------- <br /> -------------------------- <br /> - <br /> ------------`------------------------ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have ptepared this application and that the work will be done in accordance with San Joaquin <br /> i County Ordinances, State L•aws,.and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: ! ' <br /> "1 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." i <br /> Signed I ,r—� w- Own _ ._... .,� <br /> '"- ----- er <br /> Sy ----------- - --------------------------- -- -------------- Title �- <br /> f (If other#than o r <br /> ¢ fOR DEPARTMENT USE ONLY r <br /> APPLICATION ACCEPTED BY ` '-- �=-i - DATE /.�" 9-- 7-` <br /> ________ __ _'' i �.. <br /> BUILDING PERMIT ISSUED ' -------- --------•------- DATE i; <br /> ADDITIONALCOMMENTS ------I-------------------------------------- --------------------------------------------------------- - --------------•-•---------------- <br /> ---------- --------------------------------------=------------------- ------ ------ '------------------------------------------------------ ----------------------'------------------ ------•--------- <br /> --------------- ------ ------- <br /> - 1 <br /> ------------------------- <br /> ' -.------------------------------------ <br /> ------------------ <br /> - <br /> Fina <br /> -- <br /> Final Inspection by: ---I------ ------ - - Date - !' <br /> - - - - -- - --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M +�• ,a 4: w C; A.5 ��� ' �� �`.�� "'>'� C <br />