Laserfiche WebLink
FOR OFFICE USE:G APPLICATION FOR SANITATION PERMIT <br /> -------------- ----------------q-7:! --------- Permit No. 7y--8y-__. <br /> ' (Complete in Triplicate) <br /> ---------=--------- --- I <br /> ----If.- )_I---- This Permit Expires 1 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 /> described. This application is made in compliance with County Ordinanc6�d .1,14 existing Rules and Regulations: <br /> JOB ADDRESS/LOCAT ON .____ _ /LI/�`�---- T � � -�- -e_CENSUS TRACT ___________________-____ <br /> Owner's Namep —-------------------------------------------------------------- ----- -------Phone ----------------------- <br /> Address -------6.pa,3------a_uzl�c-ie v ---Z0,_ - ----------------------- City r�f �✓ <br /> r <br /> Contractor's Name _.._�C�, __J-�cs�tr. _. Lam__________________License # fT Phone <br /> Installation will serve: Reside n ceXApartment House'❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑ Other ----------------- -------------------------- <br /> Number of living units:----I----- Number of bedrooms __3------Garbage Grinder ------------ Lot Size __________________________________ <br /> Water Supply: Public System and name -------------------------------•-•-------------------------------------•--------------------- -----------------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 /> t <br /> PACKAGE TREATMENT [ ] SEPTIC TANK• Size---------- -------------------------- Liquid Depth ------- <br /> ----------- <br /> Capacity -,12.0-0------- Type�W-I'_67577 Material__"t m. ---___-_-- No. Compartments <br /> -- --- <br /> Distance to nearest: Well <br /> ��- ---------------------Foundation ------IQ-r----- prop. Line ------ --------- <br /> LEACHING LINE No. of Lines ------- r <br /> __ Len , of ach line_____ __ ._.__ Total Length <br /> D' Box CAxo_=__ Type Filter Materia]"_J&A—__-Depth Filter Material -----/� __--_________________________ <br /> Distance to nearest: Well ---------- Foundation ....lP__�_________ Property Line ___,5---------­...... <br /> SEEPAGE PIT j Depth ___/C2_________ teeter 4)(�__ Number ---------7— ___C�Rock Filled Yes K No i❑ <br /> Water Table Depth -------Z5" -------------------------------hock Size -- --L-X--1--------- <br /> Distance to nearest: Well _____________________________________-_Foundation -------------------- Prop. Line __.______-_.___..�__.. ' <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------- Date -_--------------------------------) <br /> SepticTank (Specify Requirements) -----------------------------------------------------------------------------------------------•--------------------------•---------------- <br /> Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ <br /> ------------------------------------- ----I------------------------------------------------------ ------------------------------------------------------------------------------------------------------- <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 /> "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 /> as to becom ubject to Workman's Compensation laws of California." <br /> Signed --- ___ �c� _-_____. Owner <br /> 8Y ---------------- ----- ---- .-L��= l-- ------------- Title ---------------------------------- <br /> -- --- -------- <br /> (If other than o ner) <br /> FQR PEFA—it-IMENT USE 0101ILY <br /> APPLICATION ACCEPTED -------- - - ----------- ---- ------ DATE --- -----2`_l!�-'7 5e...------. <br /> BUILDING PERMIT ISSUE ---- -----------------------------------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS __._ <br /> ---------- ------------------------------- ----------------------------------------------------------- ------------------------------------------------------------------------------------------ <br /> ----------------- -i"_ <br /> ----- ------------ <br /> ----------- - ------ - -- ----- ----- --------- - <br /> ---- ----------------------------- <br /> Final Inspection by --------------- <br /> ----- -- - --Date - <br /> ------------- - <br /> SAN JOAQUIN C L HEALTH DISTRICT <br /> r E. H. 9 1-'68 Rev. 5M <br />