Laserfiche WebLink
' FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 7 <br /> (Complete in Triplicate) --37/ <br /> ' � Per.�nit No. <br /> .........................-..................... 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 Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION .:............ <br /> — ,1� Q._. ,1 CEN5ll5 TRACT <br /> Owner's Name �............ J. .1 �1-C9 � -.. _ . �_ .� — ._ . - - _ .._.: <br /> •----•.............. . ............... ''Phone :r' (66:=:1,/..'7.P <br /> I IIf <br /> Address - ........................ ...... City <br /> �_- .QContractor's Name ._- . tP <br /> hone :,1a� r _ <br /> Installation will serve: Residence [Z Apartment House 0' <br /> Commercial C]TralIer Court <br /> i <br /> Motel ❑Other ............ .......... <br /> Nunits:._.. ._. <br /> .._., Number of bedrooms ____. Garbage Grinder __.......... Lot Siz <br /> umber of livinge .. ��..___.... y <br /> I <br /> ;Water Supply: Public System and name ............................... � <br /> ............................................................ <br /> Private ❑ <br /> 4Choracter of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ <br /> . Hardpan ❑ Adobe'tt Fill Material .........J.- If yes,type ...................... i <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 <br /> ] Sixe....... ;... ._....ti:_._,r Liquid Depth .......................... <br /> Capacity •------•--_---•--- Type -- ;:...,.. Material.----.....'.... No-)Compartments .........„•......... <br /> Distance to nearest: Well _________________'Z! Foundation" ____..5_....___.... Prop. Line ..................... <br /> LEACHING LINE X No. of,Lines <br /> ........J_...._____.- Length of each line------- r Y <br /> Total Length _.. __.._.,..----• <br /> a <br /> D' Box Type Filter Material �_� '' <br /> ---- ----• ....... _. _.. p r Material �._._ . <br /> i � f lJ J i <br /> Distance to nearest: Well .._.....___. Foundation t Fi t __ Property line ....� .. . .. <br /> cc�� i , f : <br /> SEEPAGE PlT, [ Depth '_._._c _ __-- Diameter ---c5 Number .._..__ ..f.............. Rock Filled Yes No ❑ <br /> Water 7able--Da th. <br /> i <br /> P . _ - ....... 4 .................Rock.Size .- f <br /> Distance to nearest: Well } <br /> ` - -• Foundation' .'= Prop. Line .... ...... <br /> REPAIR/ADDITION I Prev. Sanitation'Permit q4E ... Date <br /> QQ ..._.__.....................•..._....._.. ......._.................:_.......1 <br /> j <br /> F•yIf <br /> Septic Tank5 eci Re uirements <br /> Disposal Field (Specify Requirements) -------------•-----yam `� � ���__ � .., ._..���`,�Y�a:_-•-w_-... <br /> ------------ -------------• ; <br /> --- ---------------•- -•- <br /> ...................... <br /> ...................•-•----•-•--•---- - <br /> (Draw existing and required addition on reverse side) <br /> � _ <br /> .I hereby certify that I have prepared this application and that the work will be done in z a_ cardance with San-Joaquin <br /> `4 County Ordinances, State Laws, and k Rules and Regulations of the San Joaquin Lacal°'Health District. Home owner of liceet- <br /> sed agents signature certifies the following: <br /> �.. ~1_ ,, <br /> "I certify that in the performance of the work for which this permit is issued, I shall nsit`ernpl`oj any person in suehyrnannw <br /> as to become subject to Workman's Compensation laws of <br /> r <br /> --- . Calif <br /> ornia.- <br /> Signed ... .................................•-- Owner <br /> By _ _ _ ,. . . .... -•••-•--.... <br /> Title ...... <br /> (If other than owner) <br /> FO EPARTME;:NT USE ONLY <br /> APPLICATION ACCEPTED BY ........ DATE.....-. •'._ _ <br /> BUILDING PERMIT ISSUED E <br /> -- - DAT --- .................•-••......---•-•...... <br /> 71 '1,.�C <br /> ... ... <br /> ..V..--.r . ... I ..................... '-- ....._..._..;...... ...................... <br /> ................I------------------------------------------ <br /> .... . ----••--••• ------------- ....................................I........ <br /> --•-•--•. .. ...•---....-- -• .........................._............... <br /> .. <br /> .......................... <br /> Final Inspection.by:. .:. . . - :._.. _...... <br /> �""J ry <br /> .............. �_... _ ._ - Date. .....--•-- .- <br /> / SAN JOAQUIN AOCAL HEALTH DISTRICT <br /> ::7f H. 1.3 24 1-'68 Rev. 5M <br />