Laserfiche WebLink
FOR OFFICE USE: APPLICATION AOR SANITATION PERMIT <br /> - --- ------------------------------ Permit No. - 7 <br /> (Complete in-Triplicate) <br /> ---------------------------------------------------------- <br /> Date Issued --------- <br /> ------------------------------------------------- This Permit ExpireQ Yetar 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 compliancewith County Ordinance No. 50 and existing Rules and Regulations: <br /> ' '' -' `----- <br /> J08 ADDRESS/LOCATIO 5- -1�'----�-- / --------- ---------------- ------------ CENSUS TRACT .�--/-p--�- - ------------- <br /> Owner's Name G�'�� `� I _----- -------------------- --- ----------PhoneT_D__Q- -------- <br /> Address 1 da= "' z=- - ------- -��--� -. City �z <br /> Contractor's Name -----sa,;�� c----- f- --------------------------------------- # -------- .------ Phone --------------------- ------ � <br /> � License <br /> Installation will serve- Residence Apartment House-[] Commercial❑Trailer Court l❑ <br /> Motel ❑Other ----------------------------------- -------- f <br /> 1 .U v X-s�� <br /> Number of living units:----I-___.__ Number of bedrooms 2---------Garbage Grinder&_._ Lot Size __ ---____________________--------------- <br /> Water Supply: Public System and name ----------------------•----------- ---------------------------------------------------------------------------Private [❑ <br /> Character of soil to a depth of 3 feet: Sand'o Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe)K 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,) LN <br /> PACKAGE TREATMENT [ ]"' SEPTIC TANKM eX(,s )ie-------------------•-------------._-......._---- Liquid Depth --------------------,----- <br /> Capacity ---- -------------- Type -------------------- Material---------------------- No. Compartments -------------•- •----- <br /> Distance to nearest: Well ----- ----------s� --------------Foundation ---------------------- Prop. Line ------------•--------- <br /> �x,a' a� - <br /> LEACHING Lla' No. of Lines __._.____.____________ Length of ch line____________________.______ Total Length :__________......___________ <br /> 'D' Box ------------ Type Filter Material -----------------Depth Filter Material -------------------• ----------•-•---------- <br /> E. ' Distance to nearest: Well __.____ ____ _______ Foundation _______________________ Property Line. ----------------......__ <br /> SEEPAGE PIT - [ ] Depth -----______________ Dia r _______ Number -.._.____.____._.____-____. Rock Filled Yes ❑ No <br /> Water Table Depth ------ -------- --- -------------------=--------Rock Size -------------------------------- <br /> i Distance to nearest: Well ________ __ ___________________________Foundation ___________.._.____ Prop. Line .........._-_-_-_-.___ <br /> REPAI ADDITION(Prev.-Sanitation Permit# ----- ----'--=------------------------------- Date ------------------------------•---) . <br /> Septic Tank {Specify Requirements) ------- -� --------------------------------- ----------------- -•- <br /> ,r �c f <br /> Disposal Field (Specify' Re uirements) _____ _ 7 i_____ ____________ -------- / <br /> E _ <br /> - �- ----------------------------------------�----te r <br /> e <br /> f <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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 the work for which this permit is'issued, I shall not employ any person in such manner <br /> kas to become subject to Workman's Compensation laws of California." <br /> Signed ---- - ---- ------------ ---------- ---------------------------------------------. Owner <br /> By ------------------------------------------------------------------------------------------------------- Title ------------------------------------------­--------------- ------------ <br /> (if other than owner) <br /> ORP iRTMENT USE ONLY <br /> APPLICATION ACCEPTED i3Y = X -- -------- -- ------ -- ----------_- ATE ------ <br /> BUILDING PERMIT ISSUED -------- '------ ------------------------- ------------------ -- ---- ---------- ------- ATE --------------------- <br /> ADDITIONALCOMMENTS ------------- ------------------ ----------------- ------------------- -----------.-------- ----------------------- <br /> --------------�0 /------- ------ y <br /> -------------- ----- <br /> -S- 10—v" <br /> -------------------- ---------------------------- ---- -------------------------------------------------------------------------------------------------------------------E-----------------I------- <br /> ------------------ -- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --- <br /> FinalInspection by- ---------------------------------------------------------------------w.------------------------------------------------.Date -------------------------------------------- <br /> SAN JOAQUIN LOCAL,HeALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M` <br />