Laserfiche WebLink
FOR OFFIC! USE: PLICATION FOR SANITATION PERMIT q <br /> --------------------------------------------------------- Permit No. lol l �6 <br /> (Complete in Triplicate) <br /> _________________________________________________________ This Permit Expires 1 Year From Date Issued <br /> 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 /> JOB ADDRESS/LOCATION .---- � � --- -----•A_L_R_hQ_BT------Ay------------------------CENSUS TRACT --------_----------------- <br /> Owner's Name ---------MIqIQ_u_F_-IQ--------F--------Sjmas----------- ------------n-- ,------------------Phone .................................... <br /> -----------�/ '; �l - /_�_� 1 p � -------- �,� --. City ------!!l !Ug --------------------------------------------------- <br /> Contractor's Name ----- -----------------------------------------------------------------------.License# -- --------- Phone .............................. <br /> Installation will server Residence Rlkpartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other-------AVVEEP----l A-=--------- I,� i <br /> Number of living. units:----- ____ Number of bedrooms .3_.__.Garbage Grinder __.f 0__ Lot Size __.r -------X____3 �Q........ <br /> Water Supply: Public System and name ; = ------Private[F <br /> Character of soiVto a depth of'3 feef.' "" Sand'0 Silt[] -Clay ❑ ,Peat❑ Sandy Lod Pti .e'�Clay"Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material _&o--_ 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,) d <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size___�IYIV X_5_______________________ Liquid Depth ___7/-__.. \, <br /> y % <br /> B.1.Material <br /> Capacity Ype- <br /> No. Compartments _..._.- <br /> fCr' T <br /> Distance to nearest: Well ___SQ_ ___" _______________Foundation fp ___"�____ Prop. Line _�_... '�.... _ <br /> LEACHING LINE k<'No.-of Lines _____ 2n '_ _ Length off each line_______90 s___-_-___ Total Length _----zg-�-�--__(__----- <br /> D' BoxJ Type Filter May / a!'�8 ____Depth Filter Material -___� ._�r.. - <br /> -- - - ----- --------- <br /> Distance to nearest: Well ---------- t Foundation _�e-___"r______ Property Line 5S___7____..-_..._ <br /> SEEPAGE PIT [ ], y Depth --------- ---------- Diameter ________________ Number ------__--------.---------- Rock Filled Yes ❑ No <br /> Water Table Depth ----- - ---------__ <br /> ------------------Rock Size -------------------------------- <br /> V � <br /> Distance to nearest: Well _________ ______-___----__--_ ------Foundation _____ _______.__•_ Prop. Line ....................... <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ____________________________________________ Date ____-_____--_-..._-.--.._--_______) <br /> SepticTank (Specify Requirements) ------------------------------------------------------------------------------ -----------------------------—--------------------------- <br /> Disposal Field (Specify Requirements) --------------------------------- ----------- <br /> --------- ------ ------ - ---- ------------- _ .. :rt <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 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 /> as to b Ae subie r to W n's C peAsation laws f California." <br /> Signedr <br /> .- `f • -- -- --------------- Owner <br /> BY -------------------------------------------------- ------- ------------------ <br /> =- -- _TiK!P_: Title -• .: `-_ <br /> - -------- --------- --------- - ------- ------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _4CE"-__PftL-__--_-_a -_-__ TcR4­------------- ---------------- DATE ---- •"- '- -------------. <br /> BUILDING PERMIT ISSUED ----------------------z-----------------�--------- ----- -DATE -------------•--------------- ------------- <br /> ADDITIONAL COMMENTS ---- - -------- ---------------------- --------------------------- - ----------------- <br /> -- - --- ---- ---- --------------------------------------------------------------------------------------------- ---- -- <br /> f� <br /> Final Inspection by: ----- ------------------ ------------------------------------- --------------------Date --- �'Y---._tC1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />