Laserfiche WebLink
-- <br /> FOR OFFICE USE: ; , ,- <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No_ _____ __ __--------- <br /> ---------------------------------- <br /> E <br /> This Permit Expires i Year From Date Issued 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 /> I described. This application is mad�ee in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ------- ------ <br /> CENSUS TRACT <br /> Owner's Name ------- /r�IIrJ11'rriC1R� --- J _K_ ; ------------ <br /> � / - --_---------Phone=------------------------ <br /> Address ------- �� 7-� L �--= ---_!�F_(_D!1�_1�_R---------. Cit ��P LC7A/ <br /> Y --------------------------I-------_--_-- <br /> Contractor's <br /> --------- -----------------------_--_-- <br /> Contractor's Name .. ��-----__ ----- Phone ---------------------- <br /> - - ---------------------------=--------License # - - ------------------ <br /> Installation will serve: Residence Apartment House,❑ Commercial :❑Trailer Court ❑ <br /> Motel ❑Other ---- <br /> Number of living units.-.--/_ Number of bedrooms _____.Garbage Grinder Lot Size _ , .Q ------17 <br /> Water Supply: Public System and name ___ •1 --------------------------------------------/ -\ Private <br /> -Character of soil to a depth_of 3 feet:_„Sand Silt n-r , <br /> '0 ❑r�day El x.Peat❑4�=S-6?0rL'o�m`❑.�Clay Loam <br /> Hardpan R' ''` ' Fill Materia! -__ (�_ 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.) i <br /> NEW INSTALLATION: {No septic}tank or seepage pit permitted if public sewer is ayagpble within 200 feet,) p <br /> PACKAGE TREATMENT 1 f` t' " �l1 ' <br /> { ] SEPTIC TANK.[ ] Size:-------------------- ------_-1- --- Liquid Depth -------------------------- <br /> ----------------- <br /> ---------------- -- - <br /> Ca <br /> Capacity — { 0 <br /> P tY T Pe Material--- -- ---T E--" .1.No. Compartments •-----•----------= <br /> Length '�� ---------Foundation -- ------------------- Prop. Line -----------..:-------- <br /> v <br /> LEACHING LINE �[ J No. ofL nes rarest: ,If-'--- ---- off_;each line_____________________ ______ Total Length ,_____._-__.__ <br /> -------------- <br /> 'D' Box .__.--_--_.- 'Type F ter Material <br /> - Depth Filter, aterial -------------------------------------------- <br /> ( Distance to <br /> nearest WiE I ---------------------- Foundation -.------__-_ ------Property Line ------------------ <br /> I <br /> SEEPAGE PIT [ ] Depth __-_-__ --- ,.=z.._. f Dumber -----____--------- _____ Rock Filled Yes ❑ No i❑ <br /> f N <br /> _ i ,.eter <br /> ,jj j Water Table Depfih -__ �----------I`---------Rock Size ----- - <br /> ----------------- ••--- <br /> r� �istance-to nearest: ,-------- --------Foundation ----- --------- Prop. Line ---•--•-----------_-- <br /> —._ <br /> REPAIR/AIDDI�IGN-(Rrev. Sanitation Permit# - - ' ____ Date ___-_-______ <br /> --------------------------- 1 <br /> ------------------- <br /> Septic Tank (Specify Requir meets) ------------�______.-_ <br /> -------------------------------- ----------------- ------------------------------------ <br /> Disposal <br /> �CField)S kcify Require ents} _ST <br /> - ------------------------------ <br /> -------- <br /> ---------------------------- <br /> ----- f 1 = P�4vI <br /> . I _.. :. ,�. -------------- <br /> (Dra existing and required addition on reverse side) <br /> I hereby certify that I have�prepgreil/this apjilicbtion d-6d-that`he work will be done in accordance with San Joaquin <br /> County Ordinances, State'Laws, ,and Rules and Regulations of th6San Jaaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify t in th orman ?Ofhe work for which this permit is issued, I shall not employ any person in such manneras to becsubje Work aompensation laws of California." <br /> Signed ----- - ------- <br /> ------------------------------------------ Owners s <br /> BY --------------- ------- :' n <br /> -----�-5�` _,0------ Title . <br /> (If other than owner) t <br /> ------------- <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATION._ACCEPTED-BY.__.."____-f --t- •_ _`- ----------------- ' _ I <br /> = - - - .DATE <br /> BUILDING PERMIT ISSUED ------- ----=-----•---- --- -------�-------------- - -----•-----•---- ------------ --------------DATE ---^ _.- • ---- ------�------ <br /> ADDITIONAL COMMENTS -� 1_- ` �'`- �� - a '� ` <br /> ------------ -------------- <br /> -------- ----- --------------------------- - ► <br /> ------ - ----- <br /> --------------------------------------- ----- <br /> Final lnspe Non Iby:�-_ <br /> - --- �---------- Date ._ ,�� <br /> t SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M j <br />