Laserfiche WebLink
FOR OFFICE USE: Y APPLICATION_ FOR SANITATION PERMIT <br /> ---- ----------------' ------- -------------- (Complete in Triplicate)---------. Permit No. 3- -- <br /> - <br /> � y3 <br /> - <br /> ----------------------- <br /> - <br /> --------------------- <br /> This Permit Expires 1 Year From Date Issued Date Issued __..l--------._--. <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 7 Q 1"T /, <br /> - --------------------- -------CENSUS TRACT <br /> Owner's Name --p-��-----"- � /�------------____ -1�.- i .l_ _ Phone <br /> Address ----------- its(__-/---�- Ji `_..'� S-7-7--`--------------- City. MWAI��-- ------------------------------------------ <br /> Contractor's Name ._ I�2_ License <br /> # � Phone 7 <br /> Installation will serve: Residence ❑ Apa enfi House❑ Commercial []Trailer Court ,❑ <br /> ��77 h Motel Other --------------------- ----------------------��/� <br /> Number of living units:.-_-v umber of bedrooms ______Garbage Grinder ffCg... Lot Size ...4-C-A E-197 •-------- <br /> Water Supply: Public System and name ---------------- _- :-_7--------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: } Sand' Silt( Clay ❑ Peat❑ Sandy Loam •0 Clay Loam ❑ <br /> Hardpan ❑ Adobe'f 1 Fill Material ____ .. _ If yes,type ------------------------ <br /> (Plot <br /> ___-__--_--_-- --__(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 0 <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ I Size------------------------------------------------ Liquid Depth ----------------.--.------ 0 <br /> Capacity -------------------- Type --- ---------------- Material--------- ------- - Compartments ------..........------ <br /> Distance to nearest: Well --- ----------------------------_--Foundation -------- ___ _ ____ Prop. Line ------ -___________..- <br /> LEACHING LINE f ] No. of Lines -------------________- ength of each line-------------------------- Total Length _---- _--_---.--_----. <br /> 'D' Box ------------ Type Filter aterial --------------------Depth Filter M erial --------.-•.--------------------------.----- <br /> Distance to nearest: Well ---- ------------------- Foundation ------__--_-__-- __-_ Property Line ___-----_-___--__-...___ <br /> SEEPAGE PIT Depth r Diamet r -_ _____ Rock Filled Yes No <br /> [ l p ------------------- - ------------ Number ---------------- D <br /> Water Table. Depth ------` = `_� - ,---- ------Rock Size --------- ---------------------- <br /> Distance <br /> --- r <br /> Distance to nearest: Well ____ _ _______________________r'___:--_Foundation ___ ------------ Prop. Line --.---_-_-_._--.----._ <br /> REPAIR/ADDITION(Prev. Sanitation'Permit�# ------------ ------------------------------1Date --___-. -------- _.------------_) <br /> SepticTank (Specify Requirements) ---------------------------------------------------------------------------------• --------------------------►-•- --------------------------- <br /> Disposal Field (Specify Requirements) ........./0___2P...-- r/LT,eA-----B.5.----------- -X/-0-- ----------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> r (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 Locgil,Health District. Home owner or licen- <br /> sed agents signature certifies the following: 7_,; <br /> "] certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ----- ---- ----------------- ----------------------------- Owner <br /> By ---- s ------------------- -Title . ------------------------------------------------------------ <br /> (if other than owner) <br /> FOR DEPA-RTMENT USE ONLY ,raj <br /> APPLICATION ACCEPTED BY -------�9-O--------------------------------------------------------------------------- <br /> DATE -----7--1 -7_3--------- <br /> BUILI7ING PERMIT ISSUED --------- ----- ••-- ------------------------------------ ----------------------------------- --. ._. .._ ----------------- - - <br /> ADDITIONAL COMMENTS ------------------------ <br /> -------- --------------------- ----- ---------- ----------------------- ---------- --______..____.._________________.._...._...-=--�-__.____... <br /> l <br /> ---------- --- ------------------------ ------ --- --------- ---- _ _ _____ ___-_-----.______._____-------__----.--------__---.__...___ __._ � ______. <br /> �y -" <br /> Final Insp ion b _ -----------------------------Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />