Laserfiche WebLink
FFOR OFFICE USE: - <br /> EtPPeICATION FOR SANITATION PERMIT <br /> --------------------------------------------------------- <br /> ------------- ---------------------- Permit No: ----U._,.3�/ <br /> E- {Complete in Triplicate} - <br /> ----------------------------------------------- <br /> --.- This Permit Expires ] Year From Date Issued Date Issued --._ i '�Q <br /> Ir <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 /> �. +r: x wq� wy.� - � y. � ..,�rnw�. w..� n��41.�-• .� i.w-� - �w 7ti yr -4�-..w.v� �� �. .�. <br /> JOB ADDRESS/LOCATION . �,3�04- _ /ate _ CENSUS TRACT <br /> f ---------------- <br /> Owner's Name -- ----- 1 <�E �' -----------------.-•--------------------------- ------ -------Phone _ `-4.L --•-•-- <br /> s - <br /> Address J>S_�10..0------- _ -------------------------------------- City <br /> ---------------- <br /> Contractor's Name , _ _-- -- -r------------ -----License # DV-43 f <br /> ----- Phone <br /> Installation will serve: Residence Apartment House,❑ Commercial ;❑Trailer Court iC] <br /> t Motel ❑ Other <br /> Number of living'units:--- ______ Number of bedrooms ­2------ Grinder ------------ Lot Size -._ ____________ <br /> Water Supply: Public System and name ----------------------•--------•------------- --r.)---------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt El \ Clay El _,Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adob 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.) <br /> NEW INSTALLATION: (No septic tank or seepage it ermitted�if public sewer is available within 200 feet <br /> p p P J V <br /> PACKAGE TREATMENT . [ ] SEPTIC TANK'[] Size----- ✓-------------------------------- Liquid Depth ----------------..:_,_._.. <br /> Capacity ------------- - Type ---------------- Materia ---------------------- No. Compartments --------- ----- <br /> Distance to nearest Well ------------------------------------Fou-ndation ___-_____---_--__ <br /> "-=:_.Prop.-Line ---•------------------ <br /> LEACHING LINE E ] No. of Lines ___;-------I------------ Length of each line______-----------------------------Total Length :-------_---_-______________ <br /> i <br /> I 'D' Box ------------ Type Filter Materia! -------------------Depth Filter Material -.--------------_---------------------------_ <br /> ' Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line -------------------_---- <br /> SEEPAGE PIT E ] A i . Depth -------------------- i.Diameter Number ---------------------------- Rock Filled Yes ❑ No 0 <br /> i Water Table Depth ---------------------------------- ---=--------Rock Size ---------------------------•---- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --------•---------"--- <br /> REPAIR/ADDITION(Prev. Sanitation Permit#t-_____-."-----_______________--------------------------------------------- Date ---__-__---_______________________) <br /> Septic Tank (Specify Requirements[ _______________________________________ <br /> Disposal Field (Specify Requirements) -" ""_ <br /> ' --� < <br /> � �-->---- ��J,c1 -------- , ' 1s - -�---------------------------------------------• , <br /> --------------------------- --------------------- <br /> - --------- <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 that in the performance of tRe.,Work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Co mpensation'laws of California." <br /> - �[----------------- . <br /> :. <br /> Owner-BY --- Title _ <br /> - <br /> Ifi <br /> other than owner) <br /> t <br /> FOR dlipLtNIEEUSE ONLY <br /> � <br /> APPLICATION ACCEPTED BY --------------------- --------------------------------- DATE __ -- -p------------------------------- <br /> BUILDING PERMIT ISSUED -----------' - ' DATE <br /> ------------------------------------------- --------------------- <br /> ADDITIONAL ___ <br /> --COMMENTS ------------=--- t _____�_ -= f°-------- - <br /> k_- r _ __________________________________________________________________________________________________ <br /> • it <br /> --- ------------------ --- _ --------------- <br /> : := --------------------- <br /> Finallnspection by: -------------------------------•---------------------------------------.Date S'-U -76 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E, H. 9.-, i-'68 Rev. 5M <br />