Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT v <br /> ----------- ------------------------ <br /> Permit No. <br /> (Complete in Triplicate) <br /> ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued-,:5_:-`7E-69 <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 d existing Rules and Regulations: <br /> j <br /> JOB ADDRESS/LOCATION ._._�'�__-4_��-----,�� _ 5_� --------------------1 ------ <br /> Owner's <br /> TRACT ------------- <br /> y- <br /> Owner's Name ----------- t /1 --------------------------------- ----------- ------- --------Phone <br />= Address <br /> =�-L/= -- -- ----------------------------------------- Ci. ------ - -------------------------------------------- <br /> Contractor's Name ----------Xerlp-=,�w-7,C/_ .___.--__ � 'r <br /> ___--..License # �:�_��____ Phone .----------------------------- <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court 1[]'....�.�.. <br /> Motel ❑Othe <br /> ------------------------------------------- <br /> Number of living units:.../----- Number of bedrooms _____Garbage GrinderLot Size _______________ <br /> Water Supply: Public System and name ------------------------------------ --------------------------------------_---------._..__....._r.._Private.Q <br /> Character of soil to a depth of 3 feet: Sand'[-) Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam 'D <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,) r <br /> PACKAGE TREATMENT { ] SEPTIC TANK'[ ] Size-------- -------------------------------- Liquid Depth -------------------------- ie1� <br /> t Capacity -------------------- Type --- .--------------- Material------------ --------- No.. Compartments ------ ------ -------- <br /> Distance to nearest: Well --- -------------• ----Foundation ---------------------- Prop. Line ---------------------- <br /> LEACHING <br /> --------- ------ <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of eac line.--_----._____-----_-------- Total Length ---------------------------- <br /> 'D' Box ------------ Type Filter Material ---------------------Depth Filter Material --------------------------------------•------ <br /> Distance to nearest: Well _---- _ Foundation Property Line _.__________._ ...... <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number -- ------------------------- Rock Filled Yes [] No <br /> F14 <br /> 9" Water Table'"Depth------ 4-------------------------•y---- ---Rock Size ------------------- <br /> �► �. Distance to,.nyearest:.Well -----------------------------"'•-__-.....Foundation -------------------- Prop'. Une ...................... <br /> REPAIR,/ADDfTION{Prev. Sanitation Permit# _______.__._-------- __w______ _____________ Date __________________________________) <br /> Septic Tank (Specify Requirements) -------------- ------------ ------------------------- <br /> s <br /> ecY Requirements).Disposal Field (S <br /> -------------------- <br /> ---------------------- --- --- ------------------------------ ------------- --- <br /> - ----- <br /> (Draw%exisngand required addition on reverse side) x <br /> I hereby certify that I have prepared this cpplic� o on and that the work wilbe done in accordance with San Joaquin <br /> CountyOrdinances, State Laws, and Rules and Reg lations of the San Joaquin Local Health District. Home owner or licen- <br /> sed pg •nts signature certifies the following: O <br /> "Icrtif ho in the performance of the work for ch this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws California." f . <br /> Signed ----- ----------- Owner <br /> { (I �BY t -------------------------- <br /> "" "r�.-...- Title ----------------------- <br /> ------ <br /> : f oe - FOR DEPARTMENT USE,ONLY <br /> APPLICATION ACCEPTED <br /> ___,._ �-s <br /> ______ __ ._ F .- -- ------------------- i <br /> - - -- - - ----------� ----- �.,-- �` DATE5­ <br /> BUILDING PERMIT ISSUED -- ---------------------- -------- { DATE ' <br /> ADDITIONALVCOMMENTS <br /> ---------------------- --- <br /> --------- ------------------------------ -------------------------------- ------ <br /> ----------------------------------------------------------------------------------------- <br /> ----------- - ---------------- ' <br /> ----- --- ----- ---------------- -- - -------- ------------------- ----------------------- '_ <br /> ------ -- ----- ---------------------------------- --------------------------------- ----- <br /> r <br /> Final inspection by: Date :.. ` <br /> _SAN JOAQUIN LOCAL HEALTH DISTRICT <br />--�- <br /> V E. 9 1-'68 Rev. 5M � ,p <br />