Laserfiche WebLink
FOR OFFICE USE: _- <br /> " APPLICATION FOR SANITATION PERMIT <br /> -------- (Complete in Triplicate) Permit No. _.7I-.1._d__- L <br /> _____________ This Permit Expires ] Year From Date Issued Date Issued <br /> Application is hereb11 y 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 complidnce with County Ordinance No. 549 and existing Mules and Regulations: <br /> _.. _ - <br /> JOB ADDRESS/LOCATION . ------------------------------_"�` -�.� .. _­C <br /> —. S-US <br /> T—RR <br /> ACT <br /> Owner'sI Name -.__-- 1.1---- <br /> ---------.-Phone <br /> Address . -----.. Cit <br /> -- - y � S.S �' .----- <br /> Contractor's Narne ' c/Q <br /> i 3 F , # <br /> --------- License # ��00-;/ � Phone <br /> Installation will serve: Residence VQ Apartment-House•,[]--Commercial,.E]Trailer Court-;E)-- <br /> Motel ❑Other __.---------------------------------- - --- <br /> Number of living units:---./__-�'Number of bedrooms _ <br /> Garbage Grinder ------------ Lot Size <br /> Water Supply: Public System and name _____________________" ' <br /> ----------------------------------- Private to El <br /> Character of soil to a depth of 3 feet: ; Sand�'0 Silt[] Clay Peat 0 Sandy Loam Clay Loam ❑ <br /> z ; Hardpan. Adobe Fill Material ---- ----- If yes, type ---------------------------- <br /> (plot <br /> __-_------- ----------(Plot plain, showing size of lot, location off sy t m 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 ( ,,ASEPTIC TANK [ ] i Size---------------------- ------------I------------ Liquid Depth ------------------- __ <br /> CapacitYi-I------------------ Type ------ Material No. Compartments <br /> --- <br /> i Distance to :nearest: Well ----------- ---------------------Foundation ---------------------- prop. Line _ <br /> t <br /> LEACHING LINE ' ] No. ,of Lines,---_-- ----_--._ g - ° <br /> 9 a r <br /> ` <br /> :Length of each line__________ - _(1__.____-- Total Length ,__-�- _ <br /> D'F Box _11.... Type Filter Material ------- -"---Depth Filter Material -__--_----' <br /> Distance,to nearest: Well _ Foundation- -__ _7_::--property Line <br /> ----------------•-- <br /> 4 EEPAGE'PIT'- Depth -----1,�_-_-_--- Diameter __�,1.(��' Number -----------/------------- Rock Filled Yes ® No 0 <br /> Water Tabfe Depth --------------947--- <br /> Rock Size..—.--' <br /> ize..- = % ---`------------- <br /> t ? Distance to nearest: Well -------------------------- --------Foundation -------------- ---- Prop. Line -------- ------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit.# --------_----------------------------------- <br /> Date -------=-==---==----=----�-------} <br /> Septic Tank (Specify-Requirements) -----------? <br /> ------- " s F <br /> -----------------------------1--------- <br /> ----------- <br /> Disposal Field;(Specify;�Req uirements) _______________ <br /> `f Y <br /> ---------------- <br /> L <br /> N �{ <br /> -------------------- <br /> F �` 11 E -- ------------------------------- <br /> ---------------------------------I- ------------------------------------------------ --------- <br /> I. t (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the- work will_be--dohe'in accordance with San Joaquin <br /> County Ordinn nce`s;Stag 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 erformance of the work for which this permit is issued I shall not employ an <br /> p' ,, p p y y person in such manner <br /> as to become subject to.Workman's>Compensation laws of California." <br /> Signed ` ---- Owner- �Y <br /> ------ <br /> By --- ---- ---- Title <br /> (i ------- <br /> other than owner) ------ --- <br /> ENT USE 'ONLY <br /> APPLICATION ACCEPTED BY ------ '_ --_______ -- -- ' // / 7 <br /> BUILDING PERMIT ISSUED ---'.; , : --------------------- DATE---/F <br /> -----------------------DATE ------------ <br /> ADDITIONAL COMMEN ` <br /> fl_� Q.�7 -- - ----- <br /> i <br /> ------------------------------- <br /> - -- ------------------------------------------------------------------------------------ --------------------------------------------------- <br /> Final Inspection by: __._ -------------------------------Date <br /> t� AN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 ev. 5M f <br />