Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION: PERMIT <br /> __ .. "....'....::.:.. _,.. _ 1com*te In Triplicate) x m. Permit^No. 6 -3. <br /> Date Issued <br /> Tills Permit Expires'1 Year From Date 1:`sved •...._.....•. <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 /> JJ' <br /> i. JO8 ADDRESS/LOCATION _142- ....................... -•1.��.:...............•-------................CENSUS TRACT ................... <br /> ...Name ... LLl�'......... .........• O.CI..�i? . Ph <br /> �7 . .. ............................ ne <br /> E s� �j , <br /> o <br /> Address :_�4``7Q........!��11-Jl........• - <br /> ........ ....... city ..., ® ��* - - .......................... <br /> Contractor's Nome I <br /> ` .......license IP` _ Phone .-•---..------------ .......... <br /> installation.will.servP Residence%Apartment House Commercial oTrailer Court 0 <br /> Motel❑Other...•.... :.• - ..:.::. <br /> gunits. - <br /> I <br /> ---------- <br /> Number Of );vin _...� Number of bedrooms .._,Garbage Grinder .... .. Lot Size - <br /> _ -. '` <br /> Water Supply: Public System and name4- , <br /> .- ......- .. --...---- .Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay 0 Peat O❑ Sandy Loom 0 Clay Loam 0~� <br /> 1 •� <br /> Hardpan 0 Adobe 0 Fill Moterlol .....:_. ...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;STALLATlON: (Na septici tank or seepage pit ,permitted if public sewer 1s available within 200 feet,} <br /> _.... <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size...................... Liquid De .� <br /> .. Capacity I-----------------•- ...._.......-----•- 9 Depth ..._..:.....:...... <br /> __.._ <br /> Type -------------------- Material-....._..___.. ... No. Compartments <br /> s .- <br /> Distance`:to nearest: Well ......................Foundation _. Prop. Line...................... <br /> . <br /> •-••--.. <br /> LEACHING LINE [ ] No. of Uhes ........... ......• Length of each line.............................. Total length <br /> )' Box Type Filter Material .....Depth .Filter Materia! . <br /> ' S3 <br /> Distance;to nearest: Well .......... Foundation .... Property Line <br /> SEEPAGE PIT P4 , Depth -- {................ Diameter ......... Number ..._...-------•---- ---•-- Rock Filled Yes .❑ No Q <br /> ~----- <br /> Water Tdble Depth ----------- -•---- ••-------------------•--..Rock Size ......................... C <br /> i. Distance to nearest: Well ......................... ............Foundation ..................... Prop. Line .... ............ <br /> REPAIR/ADDITION(Prev. Sanitation Permit ` Date ............................. <br /> ' Septic Tank (Specify Requirements) l: eve :_ <br /> l! . <br /> Disposal Field {Specify. Requirements} <br /> ........... ------•------------------------------------------------------------- -•----------•-----•--•----•---•-..........-•----------•--....._... . -•-- ----•- <br /> a n, {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,?tsnd Rules and Regulations of the San Joaquin Local Health,,Disiriet. Home owner or licen- <br /> sed agents sigN4ure certifies the following: <br /> "I certify that in the performance 07f the work for which this Permit Is issued, I shall not employ any person in such manner <br /> as to become s blect to Workman's,Com tion laws of California." <br /> Signed ..... ... _ / ----------------------------- Owner <br /> EY •• ---••-•------------- -----------------------------. - <br /> FOR DEPAR MINT-USE ONLY <br /> r APPLICATION,ACCEPTED BY --- !r`-" +_ ._..,..... ........- ...DATE...--- a s .1,4�......... <br /> BUILDING PERMIT ISSUED --- ------ . ------------- ........ ........... . ----.........DATE . --•----- ............... <br /> ADDITIONAL COMMENTS ------------------- - ..._..._..._ :..... <br /> ...................... <br /> Y. <br /> ........................... .................. <br /> �- <br /> ........ SAN..... ............. ----­------------ <br /> . <br /> ........................................•-•-----•...._...-Date -�4--a�:�7._1.-------......... <br /> EH <br /> J 3 2 -6 1 v. �M JOAQUI.N LOCAL HEALTH DISTRICT 8!7[3 3M <br />