Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> -------- - � --- --:�---------------- ..� ,� Permit No. ---------------------- <br /> .tr mpleVe in Te plicate) <br /> u <br /> -- ---------------------------- <br /> o ate issued _��'_-_-_-71. <br /> This Permit'Expires 1 Year from Date Issued /" 2 <br /> 1z7 -� <br /> Application is hereby made to the San Joaquin L'gcaI Health District for. a permit to construct and instal the work herein <br /> described. This application is made in compliance with County-Or inance N 509 and existing Rules and Regulations: <br /> - <br /> �,f S TRACT -------- --------------- <br /> JOB ADDRESS/LOCATIONLG/-Af---(- - -- ------- <br /> `'� = '� G U---------------------------------- - Phone <br /> Owner's Name ��-,06?9 ) <br /> Address ; �_ City C' - = ---------------------------------- <br /> ---------------- <br /> TMAµ <br /> ------.License # - - 1_ Phone - --- ----- •- <br /> Contractor's Name ------- -- -Q_ ._ 4---"".1-------------------- <br /> ___L <br /> --------E-------- ;; �Y� <br /> Installation will serve:_ ,a, Residence partmtent House,❑ Commercial ❑Trailer Court !,❑ <br /> ._.. <br /> t Motel ❑Other --------------------------------------------- <br /> -- <br /> ------------------------------------- `---- 3 <br /> Number of living units:__---___ Number bedrooms ----.Garbage Grinder _. _____ Lot Size __ $ -_ �`' -----------------•--- <br /> GJ -----------------------------------•----------------------------------Private ❑ <br /> Water Supply: Public System and�name __ - <br /> Character of soil to,a depth of 3 feet: Sand'❑ Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam�] <br /> Hardpan ❑ Adobe Fill Material --- 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.) p� <br /> 3 <br /> NEW INSTALLATION.- (No septic tank or seepage •pit permitted if public sewer�is available within 200 feet,) - <br /> PACKAGE TREATMENT f ] :SEPTIC TANK ?ize--- Liquid Depth - -- ,----• <br /> ------------ - -- <br /> / , Gf :-�""No. Compartments Zd._ <br /> t <br /> Caparcity#/ =---------ATYp - r <br /> i Distance to nearest:-Well ___ --- -~---•-------Foundation :.__r _a--------- Prop. Line �____ ______________ <br /> , . <br /> LEACHING LINE No, of Line`s ------ Length gth of a line_.-_ �_ ------ -------- Total Length /� _________________ <br /> [D Len <br /> j 'D' Box I J---- Type Filter Material J _ ---Depth Filter Material /-------•-------------•-•--•---- <br /> { Distafice_to-nearest. Well-------fid_ �-----_Foundat-iog;•----/�__:-________- Property Line. __, __ ............ <br /> ' SEEPAGE PIT [ Depth<' t I- �ia�et�r f N-umber ____._____/----' f------- Ro/k Filled Yes ®�No I❑ <br /> t Water Table Depth -------4- ---------------------------• -. Rock Size --/��_��_� <br /> Distance'to nearest: Well -----�-/- ----------------- Foundation =-�-p--_.------- Prop. Line -.--------•-•---•----- <br /> REPAIR/ADDITION(Prev. Sanitation Permit�# ---------------------------------------------Date ----------------------------------- <br /> Septic <br /> _-______._=_____:_--------------Se tic Tank (Specify Requirements ---------------------------------- - --------------------------------------------_ ---------------------------- <br /> Disposal Field -(Specify.Requirements) ----------------------------------------- `---------------------- <br /> ------------------------------ <br /> -----:--._-------- <br /> ----------------------------- <br /> ---------------------------------------------------------- ------------------------ <br /> (Draw existing and required add itiomon-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,Iand 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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -- --------------------- ---------------------I---- ----------------------------------------- Owner �^ I <br /> BY = �'t° <br /> Title _ `- 'fes r 1--------------------- <br /> .0f other xh,�an ned <br /> F <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------------- -------------------- ------------------- ---- DATE -7�Z 5-:; �--------- <br /> BUILDINGPERMIT ISSUED --- ---I------------------------- ------------------------ ------------------------------------I---------DATE ----------- -•------------------ ---------- <br /> ADDETIONAL.COMMENTS ---------� --------------------- • ------•-----------------------------------.--- -----=-=�` ----- --,. -----------------------------•---•-•----• <br /> S ! <br /> ----------- ----------------------------- ----------------------------------------------- s-------------------------------------- <br /> °+ --------------------- -------------------- ----- <br /> - - <br /> ---------------------'." - — ----- <br /> Final <br /> - - ---- - -- - <br /> Final Inspection by: -- -------•------------------ -------- ------ -Date u <br /> - -------- -- --- ----- --- -- - - <br /> SAN J r AQUIN LOCAL HEALTH DISTRICT j <br /> S <br /> !Y <br /> E. H. 9 1-'68 Rev. 5M <br />