Laserfiche WebLink
F FOR OFFICE USE: t. , w'- ; � { <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------- ------ --- ----------------------------- <br /> (Complete in Triplicate) <br /> Permit No. ----------------- --- <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 /> descri-edThis�applicationisTadefinxca'` nce w tliCounfy Oine No. 549 and existing Rules and Regulations: <br /> y w� l o <br /> JOB IDDRESS ATf'O'N ' = � Y/r- L-C-- -IiAISUS TRACT ------� --------- <br /> Owner's Name - cJ �---`------------ [}F'� f Phone <br /> Address 1_5 = W = - 1 :- ------------ City 2 <br /> Contractor's Name _ ------ <br /> U -- -------------.License # e rfCJ � Phone �...3--_---?----.- <br /> Installation will serve: Residence ❑Apakt'ment House❑ Commercial: railer Court C] <br /> k <br /> Motel ❑ Other _I1? QR , - __._�Ar—V� <br /> Number of living units:-- Number of bedrooms :--___----__Garbage Grinder ___—___ Lot Size ----------------__------------------------- <br /> Water Supply: Public System and name ----- ----------------- --------------------------------- ------------------------------- -----------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam �iay Loom.0 <br /> Hardpan ❑ Adobe'❑ Fill Material __l-VV_`_ 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,) ` n <br /> PACKAGE TREATMENT [ 1 SEPTIC TANK [ )_ Size--------------- --------------------------------- Liquid Depth ____.._.__._____-_____.--- <br /> Capacity ------------------ Type -----------------T---Material------------------------- No. Compartments ---------------------- <br /> Distance to nearest: Well ---------------t------------------------Foundation --------- ------------ Prop. Line --------- <br /> LEACHING <br /> -------LEACHING LINE [ ) No. of Lines ------- -- ------ Length of each line---------------------------- Total Length -----------,-_----___-.--.-_ <br /> 'D' Box ---------__. Type Filter Material. ___-----------------Depth Filter Material -------------------- -------- <br /> vU <br /> Distance to nearest: Well -------------_--------r Foundation ---------------------- -- Property Line ------------------------ <br /> SEEPAGE PIT [ ) Depth -------------------- Diameter I--------------- Number ------.------------------ ___ Rock Filled Yes E] No C] 10 <br /> Water Table Depth ------------------------------------ ---- Rock Size -------------------------------- <br /> Distance to nearest: Well -----------------------------------------Foundation -------------------- Prop. Line _-_--______-___-.--.•_ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------­-------- -------------------------- Date -------------_______________-_-.--) <br /> Septic Tank (Specify Requirements) ---- --------------------------------------------------- ` : s <br /> Disposal Fiel (Specify Requirement -C:,-C.---"-- 2",- -�------- fes --------- \ <br /> x ___ F <br /> --------------------------------------- --------------------------M------------ -- - --------- <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 t in the rformance of the work for which this permit is issued, I shalt not employ any person in such manner <br /> as to be me ubj "o Workman Compensation laws of California." <br /> Signed -- -- --------- _ `- - -------------------------------------------------. Owner. <br /> By -- -- ---------------------------------------------------- ------------- AA Title --------------------------------------------- ------------------------- <br /> (If other than owner) <br /> FOR .DEPARTMENT USEAONLY <br /> APPLICATION ACCEPTED BY ------- 1 ---------------------------------M--/---------------------------------. DATE f 1_,l-.-: G--- ------ <br /> BUILDING PERMIT ISSUED -------------------------------------------------------------- ------------------------ ---_-DATE ----- <br /> ADDITIONAL COMMENTS --- - ----------------- ------- ---------------------------------------- ------------------------------------------ <br /> ------------------------------------ - ----- ------------- --- - ---- - - -- ---------------C------------------------- ---------------------------------------------------------------------- <br /> --------------------------------- ------- --------------- - ---------- ----- -- <br /> ------------------------- <br /> - <br /> ------------------------ == = = = - r� - <br /> Final Inspection - �--------•--------=- ------- ----------------_-Date / `� ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />