Laserfiche WebLink
FOR OFFICE USE: } <br /> APPLICATION FOR -SANITATION PERMIT ,�9 <br /> ----------- O------------ -------------- ---- _ -/ <br /> y p P l Permit No.. _7A 5 <br /> (Complete in Triplicate) � , <br /> Date issued <br /> ---------- This Permit Expires ] Year From Date Issued -- <br /> Application is hereby made to th i 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 --.--- � - .-�� sT ------------ ---------- -- - <br /> �� - CENSUS TRACT ---- -----------•------- <br /> Owner's Name - �f e�------- --Jclj_ --------------------------------------------> ---------Phone <br /> Address ( ��`� --- ------ ------------- City - i -_ <br /> ---- ---- ---------•---- <br /> Contractor's Name _ __ __ ,-:---------License # 2S'`1</Z_ Phone <br /> Installation will serve: Residence (Apartment House❑ Commercial :❑Trailer Court i❑ <br /> ll <br /> Motel <br /> ❑Other <br /> Number of living units-----(______ Number of bedrooms ____ Garbage Grinder ------------ Lot Size -- .SX-- . <br /> Water Supply: Public System and name Private <br /> Character <br /> ❑ <br /> Character of soil to a depth of 3 feet: Sand'E] Silt Clay [] Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe 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.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ j Size__________________________ ----- --- Liquid .Depth ----------------- <br /> --------- <br /> Capacity <br /> __ <br /> Capacity - ------------------ Type -------------------- Material------------------ - - No. Compartments -----------------= <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----_----- :_.---- VLEACHING-LINE,. [ ] No. of Lines _____________ _____ Length of each line --------------------------- Total Length _________ Q <br /> r ��r�� 'D' Box -__ ______._ Type Filter Material ____________________Depth Filter Material <br /> -------------------------- <br /> Distance to nearest: Well ----------------------- ,Foundation ------------------------ Property Line ------------_-------_--- <br /> SEEPAGEPIT [ j <br /> Depth _ _ Diameter z <br /> �� p i- / ___ Number ----------{----- --------- Rock Filled Yes No ❑ <br /> � /��✓/ Water Table Depth -------1a-O---------------------------------Rock Size � :_-- <br /> 1✓7f <br /> Distance to nearest: Well ____..495� z✓'�----------------Foundation ------ _______ Prop. Line ---74................ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------- } <br /> t - <br /> ---------- <br /> Septic Tank (Specify Requirements) ___________________________._----------_______-____-_-- <br /> Disposal Field Specify Requirements) <br /> - -------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I 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 /> as to becomes ect to Workman'sCom ensati.on laws of California." ; <br /> Signed Owner <br /> BY (ff--- -- - -- -- ---at er thano er) - Title , <br /> ---------------------------------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- DATE `b _r '� �a' <br /> BUILDING PERMIT ISSUED -- ----- -------------------------------------------------------- -_----DATE -----------------------_- <br /> ITIONAL COMMI NTS ________-__- .___________ <br /> ------------ ------------------ <br /> - -------------------------------------------------------------------------------------------------------------- ------------------------------------- <br /> - -- ------ -- <br /> ------- --------------------- <br /> ---------------------------------- ------------------- ---------------------------------------------------------------- --------------- <br /> Final Inspection by: Date _ <br /> -- ----------------------------------------- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E, H. 9 1-'68 Rev, 5M C�� <br />