Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> -------------------------------------------------:------ a..------- ----- <br /> -------------- <br /> (Complete in Triplicate) <br /> --- ------I------------—-------- -k---------------------- f Date' Issued 4r, <br /> ---------- <br /> -- -------------------------.... -- --------- ------- - This'Permit Expires 1 Year From Date Issued <br /> - - T <br /> 1 1 i t` i % <br /> Application is hereby made to the San Joaquin Local Health District for 6 permit to construct and install ihPwork herein <br /> described. This application is made in complianc'6With County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESSAOCATION -0---------------_.CENSUS TRACT -------------------------- <br /> Owner's Name -------------------------------------------------------------------P h o n e <br /> --- --------------------------------------------- <br /> Address .... A-;--- P_kll M -------------------- city W 51 <br /> Contractor's Name _71�190>Ale------------------------------------------------- ---------License *2 PhoneS��n---- <br /> Installation will serve.- Residence F] Apartment House,E] Commercial [ITrailer Court ',F] <br /> Motel El Other <br /> Nu.mber of living units:,--/------ Number of beclrooms�-------Garba-ge Grinder -—------- Lot Size oms------------- <br /> Water Supply: Public System and name ----------------------------------­--------------------�__:---------------------------------------------------Private <br /> Character of soil to a depth of 3 feet. Sand'LK Silt[J Clay E] Peat El Sandy Loom ❑ Clay Loam.E] <br /> Hardpan E] Adobe E] 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 seepa e pit permitted if public sewpr is available within 200 feet,) <br /> _V <br /> 7_ <br /> PACKAGE TREATMENT SEPTIC TANK Li <br /> %e-- 7'V ----- <br /> Liquid Depth _ !t_____________,_____Size ---n --- <br /> Capacity AA049---jype?&J�W_ Material No. Compartments ��------_----- 1,1 <br /> I k 64 jr <br /> Distance to nearest:,Well :--__e.______________________Foundation _/0--------------- Prop. Line _I-'!_________..__._... <br /> lrCe. <br /> 40' <br /> LEACHING LINE No:--of,Lines Length of each! fine___�70-- --------------- Total Length=2_1,0_1............... <br /> D-Box --- Type;Filter Material A74e*K-------Depth Fitter Material /'?____________________--________-______ <br /> Distance <br /> 1?------------­----------------------- <br /> Distance to nearest: Well _.14-4_'_______ Foundation ---------- Property Line. -07------------------- <br /> SEEPAGE PIT Depth ------------------ Diameter ---------------- Number ---------------------------- Rock Filled Yes E] No 0 <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest. Well ________________________________________Foundation -------------------- Prop. Line ------------------------ <br /> REPAIR/ADDITION(Prev, Sanitation Permit# -------------------------------------------- Date--n------------------------------- <br /> SepticTank (Specify Requirements) -------------------------------------------- ------------------- ----------------I----------------------------- ------------------------- <br /> I <br /> DisposalField (Specify Requirements) ..................... ------------------------------------------------------------------------------------------------------- <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 /> "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 become subject to Workman's Compensation laws of California." <br /> Signed --------------------------- -------- Owner I <br /> AW ------------------ <br /> e�------------- "IM _Z <br /> By ------- ... Title OU---------- _7 <br /> ----------- ----------------------------- <br /> (if other than owner) <br /> FOR PAPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- G. -- -------------------------------------------------------- DATE .... <br /> BUILDINGPERMIT ISSUED ------------------------------------ ---------------------------------------------------------------------DATE _--------------------------------------- <br /> ADDITIONALCOMMENTS --------------------------------------------------------------------------------------------- ------------------------------------------------------------------ <br /> ---------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------- ---------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------=----------------------- <br /> ----------------------- <br /> ---------------------------- ------------------ <br /> ------------------------------------------------------------------------- <br /> ;11------------ ---------- ....... . <br /> --- -----------------------------------Date ...... <br /> _e Final Inspection by: --------------- - ------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev_ 5M <br />