Laserfiche WebLink
FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT 7s-_ ,S-,77 <br /> Permit No. ..................... <br /> (Complete in Triplicate) <br /> ................•-••----•.. ..................... <br /> Date Issued . .­.......���� <br /> .................. 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 <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> 1� <br /> JOB ADDRESS/LOC TION . .-- -------------------------- -----.._..�........._............................................CE:N5U5 TRACT .......................... <br /> Owner's Na e _ .............................. Phone g. • <br /> --- --- - -- ---- --- - ----- <br /> Address <br /> .. <br /> City .......................................................... <br /> it <br /> Contractor's Name _ ---------------------------------License # ........................ Phone .............................. <br /> Installation will serve: Residence ❑Apartment House] Commercial ❑Trailer Court 0 <br /> Motel [Other <br /> Number of living units:...-------------- Number of bedrooms ------------Garbage Grinder ....._..---- Lot Size ............................................ \} <br /> Water Supply: Public S�stem and name --•......... ---•----•• ......................--•----------- -------- ..............................Private ❑ <br /> Character of soil to a depth of 3 feet- Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Cloy Loam ❑ <br /> °• Hardpan ❑ Adobe ❑ 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 reverse side.) 1 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f j Size--------------_------•------••---.---•-__ ---- Liquid Depth ...--_--------_._.------ <br /> Capacity ..`c�r9b` Type __... Material-_C.0VP*.t.... No. Compartments X--.. <br /> Distance to nearest; Well .__...--1Q.......................Foundation .1a............. Prop. Line . <br /> LEACHING LINE No. of Lines � <br /> E l . Length of each line.._..��._. ��..._. Total Length � <br /> •D' Box ............ Type Filter Material54.Tue _--Depth Filter Material ------ ............................... <br /> Distance to nearest: Well .............:.......... Foundation ------_-----------__ Property Line ................... <br /> -i <br /> SEEPAGE PIT j ) Depth Diameter ................ Number ..: "'." -=-:._ ---_.__ Rock Filled Yes ❑..._.. No ❑ <br /> Water Table'Depth *`- -'Rock Size - <br /> f ---------------- ......... <br /> 21 <br /> ... Prop..,Line <br /> Distance r to`-'nearest:°Weil ._..-•......................------•-�'.--Foundation --------------_-- . <br /> p. ..................... <br /> 'hi-_RE AIR/ADDITION(Prev. Sanitation Permit°# <br /> ............................................ Date................................... <br /> Septic Tank (Specify Requirements) <br /> _...............•--•- ------•-- ... .. - _............ _.._. <br /> t ' V 1. a <br /> Disposal Field. (Specify Requirements) `...---- ---••--••------•--•-----•••---•--------------•----•-••--••-•--.................•--- -------- -------- <br /> ----------------...........•____.....................---------------------------------------------------------------------•---------_.............................___•-----------•----------------- <br /> ------------------------- ---------------------­­--------------------------------------------------------------------------------------------- ...................... ........ .......... ......... <br /> --------•-•-----_....__•.................._ .....••-------------,-..._......___-----------•---•----•••••--•----------•-•••------•-----•--•------••----•----•---....-......................_...................._......... <br /> (Draw existing and required 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 th g: <br /> °'I certify t e rf ante of the fork for whit this permit is issued, I shall not employ any parson in such manner <br /> as to come ub' o War Co ens on I of California." <br /> Signed .............•--- ....... - ................... Owner { <br /> Title <br /> (If other than owner) <br /> FOR DEPA ENT USE ONLY <br /> --•........APPLICATION ACCEPTED B ... . .. .. DATE ......!1: P!707 ... <br /> BUILDINGPERMIT ISSUE --•--•--------------•---••-•-....-•---------..........---... ........ ........................DATE ........................................... <br /> ADDITIONALCOMMENTS ................................................................. ......------------------................._..............----....I..•--...................... <br /> .................................... •---......•-•-•••---.................---......... •-•--........................................... <br /> ..... <br /> -•.- . .••..•.--.... .............. <br /> ................: ... <br /> �Q -- <br /> Final Inspection by' -------------•- ------,..............Date ............................................ <br /> SAN -JOAQUIN -LOCAL HEALTH DISTRICT <br /> E.HJ3.. 4 1.'68 Rev..SM — — - - - ---- -- - 7172.3 H <br />