Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> _ <br /> - .. .. ...` ....... ...................... <br /> ....••4111 <br /> (Complete in Triplicate) Permit Na. ....7.�{'....�.. <br /> ..................••-•........ ....................... <br /> This Permit Expires 1 Year From Date Issued 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. 544 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ...336..S.- Ad.rienn.e- ..............CENSUS TRACT ....... ........... <br /> . . ........ <br /> . . <br /> wner's Name .....EGalle <br /> ...:.............tti tti........ ... .........................................-...........----...-•••-:.....................Phone .................................... <br /> Address ...... ..............604-.E-.1 r--ket...................................................... City -Stookton......................................................... <br /> Roto Rooter Skwer Sevvice 271539 . Phone !�65-2616 <br /> Contractor's Name .......................... ........ . -- License # . . . ......... <br /> Installation will serve: Residence M Apartment House❑ Commercial ❑Trailer Court <br /> Motel ❑Other ............................................ <br /> Number of living units:....'...... Number of bedrooms .3.........Garbage Grinder nP....... Lot Size ...60 x 1.1.0 . <br /> Calif. Water $'er. ........Private <br /> Water Supply: Public System and name .. ............ ......... . ..�,............................ ........._.-.....---...... •----------• ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ $ikt3 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan❑ Adobe Fill Material .....no... 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.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted,if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size................................................ Liquid Depth .......................... <br /> Capacity .................... Type .................... Material...................... No. Compartments ...................... W <br /> Distance to nearest: Well ....................................Foundation.............. . Prop. Line ...................... <br /> LEACHING LINE [ j No. of Lines ........................ Length of each line.............................. Total Length ............................ <br /> D' Box Type Filter Material Depth Filter Material <br /> Distance to nearest: Well ........................ Foundation ....__....,.._...._...._ Property erty line ........................ <br /> SEEPAGE PIT- [ ) Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No Q <br /> Water Table Depth ................................................Rock Size Q► <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ..................... 17 <br /> r. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date.................................... <br /> Septic Tank (Specify Requirements) ..............vtdd..4Q'...1each mg..lxme.._arkd..1n33."..Ain...by 25'-Pit........................ <br /> DisposalField (Specify Requirements) ............................... ..................................................................................................... <br /> ...........................•------------------------.....--•-------- ..................... -----------------•--•--------.............._...........------•.........--•---------. _...._........_..._..-. <br /> -------•--•.. ................................•---. ........................................................-............................................................................................ <br /> (Draw existing and.required addition on reverse side) <br /> 1 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 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 suck manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .......... . .................�....... . .................._..._.............. Owner Contractor <br /> . T <br /> hitle ... <br /> f 0 e�an owner) <br /> FOR DEPA TMENT USE ONLY <br /> APPUC TON ACCEPTED BY..' .. DATE ........: .1.4 <br /> BUILDIPERMIT ISSUED .................... ..................:.................................................................DATE .......................................... <br /> ADDITIONALCOMMENTS ...................................................•.............._..........----..........._,..........-._........_..............:.••-•.........,............ <br /> ............................•----.....-•---..,.......,...........--•---•........... ............ .. _;. . ..... ....._-......................................._....--.._................... <br /> ............................................... �:. . <br /> Final Inspection by. .. ...cry �....__., .. .............................Date ,... ...... ..... ...... ...... <br /> ✓ SAN JOAQUIN LOCAL HEA1.4-DISTRICT <br /> E. H.13 241.'68 Rev. 5M 7/723X <br />