Laserfiche WebLink
j FOR OFFICE USE: <br /> E, # 'APPLICATION FOR SANITATION PERMIT 7 <br /> (Complete in Triplicate) Permit No:!d - <br /> -------------------------------------------- <br /> --------------------------- Date Issued <br /> ------ This Permit Expires I Year From Date Issued 46 116--74 <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'7_,. +A__ Q '� .------CENSUS TRACT -------------------------- <br /> Owner's Name -------•---------- <br /> � --------------------------- --- ------ -----�------- --- ----- -Phone ------------------------------•- - - <br /> €I Address __ _144 - fLf/E--- --A-,�--------- __. City -��7` .� <br /> -------------------------------- <br /> Contractorl'Name .--11(7�E-5 ----�� .License # _ Phone <br /> ------------- <br /> Installation will serve: ResidenceJ)�Apartment House❑ Commercial : Trailer Court ;0 <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:.-._ __-. Number of bedrooms _--o-L-_Garbage Grinder -NP Lot Size --5�'f"- --..36,61---- <br /> Water Supply: Public System and name -------------------------------------------------------- <br /> p t ------------------------------------------------------PrivateECharacter of soil to a depth of 3 feet: Sand'X Silt 0 Clay ❑ Peat❑ Sandy Loam •❑ Clay,Loam. <br /> n <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,) ` ` f <br /> (PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size <br /> ------------------- - _ <br /> Liquid Depth ----------------- <br /> ---- V r <br /> i • <br /> Capacity --------- TYPe -------------------- Material---------------------- No. Compartments ------------ <br /> Distance to nearest: Well ------------------------------------Foundafion ---------------------- Prop. Line ----------- - <br /> LINE <br /> ` [ ]' No. 6,f L•rnes ------------------------ Length of each line --------------------------- Total Length <br /> II� 'D' Box _--- ------- Type Filter Material --------------------Depth Filter Material --.--_------ <br /> --------------•----•-•---------- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line -------•----.--- <br /> !SEEPAGE PIT [ ] 'Depth ---__,_�.-.__ -.--__- Diameter <br /> — Number ---------------------------- Rock Filled Yes '[] No is <br /> EY , <br /> Water Table Depth ------------------------------------------------Rock Size <br /> Distance to nearest: Well ----------------------------------------Foundation ---------------. -- Prop. Line --------------,-------- i <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------_-_------_-----_-------------- Date ---------_---•_ <br /> - ,. ------------ 1 <br /> + Septic Tank (Specify Requirements) ---_----__--- <br /> ----------------------------------------------------------- ---------------------------------------------------- <br /> Disposal Field (Specify Requirements) --�-:.ASW_ jVlj �--------------- <br /> i - ---------------------- <br /> ------- ----------------------------------- <br /> --------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> li 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. Horne owner or licen- <br /> sed agents signature certifies the following: <br /> a1�1 certify that in the performance of-the work For which this permit is issued, I shall not employ any person in such manner <br /> s to become sub[e it to rkman's Compensation laws of California." <br /> g <br /> Signed <br /> i --------- -------------------------------------] Owner <br /> By ------------------Ilf-- ot-- --h-er- ---th- -an owne- -- ----=---d----t-------- ---- -Title -- ---------- <br /> - -------------------------------------------------------- <br /> FOR DEPARTMENT USE ONLY <br /> AIPPLICATION ACCEPTED BY - <br /> - - -- ------------------------------ = ------- . DATE �l <br /> BUILDING PERMIT ISSUED _----(_ -- -- `--_.-- - <br /> ------------- <br /> = ----------------------------------------------- <br /> ---- ---- -----------------D-A---TE ------------------------------------------ <br /> -- -- - <br /> ADDITIONAL COMMENTS ------------------- ---------- ------- -----------r <br /> -------------------------------- -------- ---------------------------------- <br /> -----•---------------------------- ------------------------------------ --------------------------- <br /> -------------------------- <br /> ----- ------------------------------------------ --- <br /> t <br /> -Y=Final Inspection b --- ------------- <br /> '/- '�C�-------7 _-- <br /> --------- - -------•-- ----- ---- ----- - - -- -- - ----------- -Date ---4- - - ---- <br /> SAN JOAQUIN LOCA^L HEALTH DISTRICT <br /> E.'H. 9 1-'68 Rev. 5M. <br /> i1 <br />