Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR- SANITATION PERMIT / <br /> �- <br /> _Permit No. <br /> --- ----------------------------------- <br />--------------- 1 v.. (Complete in Triplicate) <br /> ii <br /> ---+--------------------------I- Date Issued <br />------------------------- <br /> �1 _ This Permit Expires 1 Year From Date Issued <br /> -----i-- --- - <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct a install the work herein <br /> described. This applicati nis tmade in compliance with County Ordinance No. 549 and exist u1s �' e9ulations: <br /> !z <br /> D , � 5�r SUS TRACT ----------- -- -------- <br /> JOB ADDRESS/LOCATION , � '.�?l�/f, f -7. .tl <br /> f _ 'l ` Phone . <br /> Owner's Name - - -- l.�-�� ��-------�------- ---------� ---------- -------- --- <br /> ------------- -------- <br /> Address _- - Ci _ <br /> ' - .' _.License #���-�- --�_ Phonel�--�� <br /> Contractor's Name . -- <br /> Q7a - ---- -- -- - <br /> Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court <br /> Motel ❑Other,,:.aA <br /> Number of living units:------ Number of bedrooms _X----Garbage Gender . Lot Size�44v ------- <br /> iI --------------------------------�'l_I-------------------------------------------------Private'j <br /> Water Supply: Public System and name ---------------------��-------•------- ----- � <br /> Character of soil to a depth of 3 feet: San cl�g Silt[] Clay ElPeat El Sandy Loam -El Clay Loam ❑ <br /> p <br /> Y e ---------------------------- <br /> !� ��. r H� ardpa�n�❑ Adobe El mill Material _.-�-------- If es, type <br /> g <br /> (Plot plan, showing size of lot, location of system ifi relation to wells, buildings, .etc. must be placed on reverse side.] <br /> NEW INSTALLATION: (Nol septic tank or seepage pit permitted i wppublic sewer available within 200 feet,] <br /> ' - ! _1lev--------------------- Liquid D10, epth --�, <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ] "� Size ;:-- - <br /> ` _� ---- No. Compartments ---------=---- <br /> Capaci•ty= _00_. .TYp <br /> f ,e_ / <br /> 'i Distance to nearest: Well��o----------- Foundation /% ---------- --- Prop. Line ,------ <br /> ' `` / <br /> LEACHING LINE NO, of Lines �-..--------tom- Length of !each line To#a! Length �-�U� -:--------- <br /> Ei <br /> D' Box _ss _ Type Filter Material.__ __ Depfh, Filter .Material __ --- <br /> 'I YP - Z <br /> A__'Pro er Line _ f--------- <br /> foundation fj = p <br /> Distan a to nearest Well ��-- 1 <br /> SEEPAGE PIT [ ] Depth Diameter _-- ___--- _ Number -------------------- - '+ Rock Filled Yes ❑ ,t1 No i❑ <br /> fi <br /> �3 Water Table Depth Rock Size --- ---------------------------- l f <br /> IFoundation -------------------- Prop. Line ..------'�- ------- <br /> Distance to nearest: Well --------------------------------- <br /> t IM ) - � Date--------- ---------------------] <br /> REPAIR/ADDITION(Prev. Sanitation Permit#- --_------------------ - <br /> II r -- <br /> [Sepfiic Tank (Specify Requirements) - --------------------- '. .. <br /> i r "' t ----------------------- ----------- <br /> 1 .Disposal Field (Specify IRe uirements] ___� <br /> q <br /> II - - -- <br /> ----------- <br /> ------------- ---- ----------------- ----- -- -------------- -------------- -�------ ; <br /> I ------ ----- --- <br /> - ------------- <br /> - - - - - ------------- ------ } <br /> Ij ; (Draw existing and required addition on reverse ss ] <br /> # l hereby certify that I have prepared this application and that the work well be done in accordance wide 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: E <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 /> t <br /> ...-as to become subject to Workman's Compensation laws of California." t <br /> I I <br /> Owner <br /> Signe ------------------------------ ---- - - ---- ----------- ---------- "---- ,� ��A <br /> lG-i n Title ------------------------------------ <br /> y ----------------- ------ <br /> 1-14,1 <br /> ---- - f <br /> 4, (if other owner) <br /> 1 I� <br /> FOR .DEPAttTMENT USE ONLY ` <br /> DATE L�"" , <br /> APPLICATION ACCEPTED I�BY _ :.__-:!s2 .� - ------------------------------- -------------- --DATE <br /> BUILDING PERMIT ISSUED -------- -- j"" <br /> -------- <br /> ADDITIONAL COMMENTS:---- ---------- -------------------------------------------------- ---------+.� ------------------------------------------------------------- <br /> I <br /> ------------------------------------ --------------------- <br /> ----------------------------------------------------------- <br /> ' ------------------------------'-------------------------------- ----------------------------- ------ 1 i;= --------------------------- <br /> 'l ---�----------------- ---- -- ---- --------- <br /> --=------------------------------------------------- <br /> Ea -• , ----------�� F _ --------------------- <br /> ---------------------------------- Date � ------ <br /> 6 _____________ _______ <br /> Final Inspection by: /izf .:'�� - ,_ µ <br /> F !� <br /> SAN JOAQUIN' LOC ii L,SHE-ALTFi-615TR[CT <br /> } E. H. 9 �,.1-'68 Rev. 5M• <br /> 1I' — <br />