Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br />. .......... ...... <br /> ............ Permit No. <br /> (Complete in Triplicate? <br />•...•.................................................... This Permit Expires 1 Year From Date Issued <br /> 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 /�. S�. .�/� . _//�. //�v�... <br /> , <br /> Owner's Name ' . A�� .�... ...' .Phone _ osa» <br /> . i <br /> --.... �. ... <br /> Address . ------ /i.J. rj ry ............................................_...__..... City .f,,re1.% i�°�_ -•---...--- ..........�©.....--•------ <br /> Contractor's Name ..... ............. ...............'•---------------....------._ -......License # �7-------4FSf Z <br /> -------- Phone <br /> installation will serve: Residence ❑Apartment House`Commercial ❑Trailer Court 0 , <br /> Motel ❑Other ........................................... <br /> Number of living units:............ Number of bedrooms ------------Garbage Grinder. ...___..._.. Lot Size ............................................ <br /> Water Supply: Public System and name _.4,_j. �p�...._......._. _ ......... ...........Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam [] <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,) . <br /> PACKAGE TREATMENT [ ] [ 1D <br /> SEPTIC TANK' Size...._ - •......_... Liquid Depth ......... <br /> W <br /> Capacity .. . . . Type -------------------- Material........ •' :.. ..No. Compartments .1.............. ...-- ,) <br /> $ Distance to nearest: Well .------.._.-.....................Foundation ........-..-.......... Prop. Line -----------............ <br /> LEACHING LINE [ No, of Lines`. Length of each line .........:. ................ Total-^Length:._............_........_. kA <br /> "D' '.Box; .n-,.-.�7"type",FilteO'Material'"" "—Depth Filter-Material'. ....." <br /> l c ...Distance to7Yea40.:Wefl Foundation <br /> ....................... Property Line •--------•............. <br /> . J <br /> t <br /> SEEPAGE PIT( ( ] Depth .....1.. 2... ..i« Diameter <br /> _ _­Number............................. Rock Filled! Yes ❑ No <br /> t Water Table Depth`---------------------- <br /> Rock Size ......... <br /> f t i , Is ' r <br /> I (Distance to neare`st:TWell ........................................Foundation ................_--- Prop. ;Line ...:--------._........ <br /> REPAIR/ADDITION(Prev. Sanitation`Permit# '........................................ Date ............................ <br /> Septic Tank (Specify Requirements) J.­ .................. . •-----. .-----•---.................. .. ........................... <br /> Disposal <br /> is osal FYield' (Specify RTe. u_.irernts). <br /> ------ ---- '----- --- <br /> . •-- ----- ------------- .................... --- ..- <br /> •- . <br /> t <br /> 1W(Draw existing and required addition on-reverse side) I <br /> I hereby certify that I have prepared this application and that the work :will be done in accordance with Son Joaquin <br /> F.w...�..— su -�.erw-.�.- .y.•� <br /> County Ordinances, Statertawsw, and'Rules acid 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;ony person in such moaner <br /> Signed,. .^ me subject t ork an's ompensation laws of California." . <br /> as to beco ' <br /> �:. <....... . --- ......... -___--------------------- i Owner , <br /> 'M 4yf # _ < <br /> . ............................... _.. <br /> Ir (If otherthanowner) � --.. Title . ._.. - ,f <br /> .---------------.......... .. h <br /> I -t <br /> ii j fii F <br /> l FOR DEPARTMENT USE.' ONLY <br /> APPLICATION ACCEPTEDBY I <br /> � --....................... ........ ............ DATE _..� ......... l <br /> BUILDING :PERMIT-ISSUED �Y- ........ - --------- <br /> = ---. ..DATE— .ter.-- ._ --�,.._.-._.:..:_.._, a <br /> ADDITIONAL COMMENTS ------ ........................ <br /> :.._.... _..._.. <br /> F <br /> ..............-----------................................,-------------'---------------..------------------------------------:'__-..`..-----------.-•-....-....................................... <br /> ......_. # <br /> --....----••------------------------------- <br /> --..............._,- ._._._.:.-'----=-'-•--._......._...--------------•'---'--'---------.-......._.--------..._......-----.....--•---•- <br /> �,..a <br /> Fina! Inspection by: ..---- ----- • ....... .............•....---..........I....-•-•- --- ':...................._............__.Date ...... -------I.........: ' <br /> .. i <br /> -SAN JOAQUIN LOCAL..HEALTH DISTRICT- <br /> E. H. i3. 24 1-'68 Rev. 5M 7/72 3 14 <br />