Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION>POR SANITATION PERMIT <br /> ------------ - Permit No. <br /> (Complete In Triplicate} <br /> Date issued <br />........ . .........................•--_..._..... -•- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the SZJoaquin 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 /> ,` `..........CENSUS TRACT ........................ , <br /> JOB ADDRESS/LOCATI N ..I..!6�-/_��-..�r.r�e�- ---•_. / •- <br /> Owner's Name _.._.....__.t_.U. ..1..' -!q. ti 1 t ......................................... <br /> ..Phone one . . <br /> A).. �r — <br /> Address .--........ �. _.....--•----..... ..._...................... <br /> ........... . ............ <br /> Contractor's Name -_--- -----------------...........................................License # ............. ........... Phone .............................. i <br /> Installation will ssrvd: Residence [$'Apartment House] Commercial❑Trailer Court ❑ <br /> Motel ❑Other ............................................. <br /> Number of living units:----f Number of bedrooms a Garbage Grinder 1A...... Lot Size ...................... <br /> Water Supply: Public System and name ..........=.............................................._....................................................Prlvate,o <br /> Character of soil to a depth of 3 feet: Sand-W Silt❑ Clay [j Peat❑ Sandy Loam{]. Clay Loam ❑ <br /> Hardpan E] Adobe❑ Fill Material ............ If yes,type ............... ............ <br /> (Plot plan, showing size of lot; location &'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,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK; ] Size.......................... Liquid_Depth ..;.....-----..........._.. <br /> S <br /> Capacity ------------!I----- Type ...... ......... Material...-------_---------- No. Compartments ...................... <br /> Distance to nearest: Well ------------------------------------Foundation ...................... Prop. Line ................ .. '] <br /> LEACHING LINE [ ] No. of Lines -.------I------------- Length of each line......... • ...... Total length ...:'it rl •..-•- 1*J' <br /> 'D' Box ------------ Type Filter Material TO.C.k.....Depth Filter Material ............................................ <br /> `Y` 44 .. "Foundations _... Property Line <br /> Distance to ne restFWell _..�------• <br /> SEEPAGE PIT [ ) Depth Diameter _5-K.4:.... Number .......-4................ Rock Filled Yes A No X3-11 <br /> Water-Table Depth = w -; .Rock Size <br /> t' <br /> Distance to nearest: Well ....IYf1 c.....:......... Foundation -----•----._........ Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sant tion Permit# .....---....----------------- -----:_---_- Date ._.:--.---- ..._......_.......--) <br /> ,Septic Tank (Specify Requirements) ................................................................ -----------------w........................................................ <br /> s � <br /> Disposal Field (Specify Requirements) -------- -----------------------------------------------------------•-•......................---- ----------------------------...... 'e!. <br /> ----------------- -------- ---•------------- -------------...---------------------------- ---------- --•---------------------.......-------------------............--..... <br /> --------------------------------------- -------- ---•----------------- --- ---------._ . .....--•-•-----------•------.........--•---...------................................ <br /> (Draw existing and required additlon'on reverse side) <br /> 1 hereby certify that I have•p pared 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 ifies the following: ` <br /> "I certify that In a perfor anc the w for Ich this permit is-issued, I shall.-.not-employ any person In such manner <br /> as to becorn ct ark a s Co en n laws of California." Y! <br /> Sign -_ - -- - ---- • -- - -- -------------- .............................. Owner _ <br /> BY ----------------- ---- Title ....F. •-•---................. <br /> (If other than owner) --- <br /> DEPARTMENT USE ONLY rT <br /> APPLICATION ACCEPTED BY ------- --------------------------------------------.......... DATE -- :��' ----------- <br /> BUILDING <br /> ------- -- <br /> BUILDING PERMIT' ISSUED - -- _ ---------------­----- ----DATE -- -------------------­ -------•--- <br /> ADDITIONALCOMMENTS _.-- -------- _ --- -- -------------------------••----,------------------------------------------------------- -------•-- -•_--------------------------- <br /> .- ----------------------------------- - ------ .... <br /> -.._...------•---- ------------•--- � <br /> -----•-- ------- ---------------------------------------------------------- ­ <br /> ­ --- <br /> Final Inspection b ---- -- --•• - --------------------------------------------------------- <br /> ---------------.---•-------- _.._...------ -. -.Date . - 4 7. ••---......----- <br /> p Y <br /> EH 13 24 1-58 SAN JOAOUIN LOCAL HEALTH DISTRICT 8/74 3M <br />