Laserfiche WebLink
FOR OFFICE USE: <br /> ��--.. APPLICATION FOR. SANITATION PERMIT <br /> ------------------------- �i�. Permit No: 7�-- �(�- 7 <br /> ,(Complete in Triplicate) <br /> °e Date Issued <br /> --------------------------•---------------------------- This Permitstxpires i Year From Date Issued <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 /> JOB ADDRESS/LOCATION ---N�c ---------------------------=---------- ---CENSUS TRACT --- 7---- ----------- <br /> Owner's Name - -----••---------------------- -------Phone ------------------------------------ <br /> Address Cit S'C'_o__�_-�-C'U-�---- <br /> Y - - <br /> o <br /> Contractor's --------------------License-# _O Phone ------------------------------ <br /> Installation will serve: Residence.,Appartment House❑ Commercial :❑Trailer Court 0 <br /> 4kabltiowtB... <br /> Motel ❑Other -------------------------------------------- <br /> Number of living 'units:---- Number of bedrooms ________Garbage Grinder ------------ Lot Size ____________________________________________ <br /> Water Supply: Public System and name ---------------------- ------------------------------------------------•--------------------•------------------Private <br /> Character of soil to a depth of 3 feet:._ Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy loam X Clay Loom ❑ <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.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) N <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size-----------------------------------_------------ Liquid Depth.----------------------_--- <br /> Capacity <br /> __.___.__-____-_-_._-__ W <br /> Capacity ___________--------- Type - �°e "r_ 'Material__0C7^_1CXk_k _ No. Compartments _--- ......... <br /> Distance to nearest: Well ________ __________________Foundation --------;C!--------- Prop. Line ....................... W <br /> LEACHING LINE [ ] No. of Lines -------- _----------- Length of each line______.t__ ----------- Total Length -----490/........... <br /> 'D' Box ------------ Type Filter Material ----Q ---Depth Filter Material _________If-----------------__--- <br /> Distance <br /> __________________ _---pistance to nearest: Well -----20O-------- Foundation -------L-O_'r_:_____ Property Line _____W-Z...... <br /> --- Diameter ________________ Number _.____._.__._.-_____________ Rock'Filled Yes No <br /> Depth ❑ C❑ <br /> Water Table Depth ------------------------------------------------Rock Size --------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ...................... <br /> r _ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _-_#__________________.________ --------- Date ------------------_____________-_) <br /> SepticTank (Specify Requirements) -------- ------------------------------------------------------------------------•----------------------------,----------------------------- <br /> w .. ; <br /> Disposal Field (Specify Requirements) ------------------•------------ --------------------------`----- ------------------------------ -------------------------------- <br /> ------------------------------------------------------- ---- ------------------- ----- -- ------------------------------------------------------------------------ <br /> (Draw existing and required addition on'reverse side) ;:N <br /> I hereby certify that I have prepared this application and that the wor0will 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 the work for which this permit is issued, I shall not employ any person in such manner <br /> as to b o subi Workman's Compen tion laws of California." 4 <br /> -?-Signed ------------------------------ Owner ` ,•�- <br /> tBy ------- -------- -------------------------- ------------------------------------ ---------------- -Title ------------- ----------------------------------------- ---------------- <br /> (if other than owner) <br /> FOR D ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---- ------------- ----- -----=-------------------------. DATE -----`� _ _"`2 r ------------- <br /> - ------------------------------ -- <br /> BUILDING PERMIT ISSUED -----------=--------------DATE ---------------------------- <br /> ADDITIONALCOMMENTS ----------------------- ----------- --------------------------------- ----------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- <br /> --------------------------------- ------- - <br /> -----------------------`------------------------------------------- - -------------- <br /> Zs , <br /> Final Inspection bY: -------Date --- ---- ----------- <br /> - ----- ------------------- -- -------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />