Laserfiche WebLink
FOR OFFICE USE: <br /> W `''APPLICATION FOR SANITATION PERMIT -i <br /> --------------------- <br /> �( � 4 <br /> 'Complete n Triplicate) Permit No: - <br /> ------ <br /> This Permit Expires 1 Year From Date Issued! Date Issued' <br /> - Zf3- 2-2z� n � <br /> Application is hereby made to the San Joaquin cel tHealth District for a permit to construct and install the work erein <br /> described. This application is made in compliance with County Ordina a No. 549 and xi in Rules nd ulations: <br /> 7,VVV- VF <br /> �--f -----------------CENSUS TRACT --------- --.� <br /> JOB ADDRESS/LOCATION ---' TYVI -I�--: - t�--------- ---- - <br /> Owner's Name � ) 1 ------------------- ----------Phone_//$73� f�c:Z7 <br /> Address --------�'_ _- ---- ------------------- ------------- City �������/ <br /> Contractor's Name _ ,--___-- - (��---------------------------------------License # S�� Phone <br /> Installation will serve: Residence (RApartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑ Other --------------------------------- <br /> Number of living units:-----I------ Number of bedrooms _______Garbage Grinder ------------ Lot Size ��` ''t__ .�` e ________- <br /> Water Supply: Public System and name ------------------ - ---------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat 14 Sandy Loam gj Clay Loam .0 4 <br /> --Hardpan-E] Adobe -❑.,-Fill Material _-_Ot If-yes;type—"`---- <br /> (Plot plan, showing size of lot, location of system i relation to wells, buildings, .etc. must be placed on reverse side' <br /> NEW INSTALLATION: <br /> {Na septic tank or seep pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' Size_ f Liquid Depth ?__ ___._.•....__ ' <br /> Capa ityOd------- Type _u Material--- szi_1 +�'CpNo. Compartments ------------------ <br /> istance to nearest: Well --- ----------------------Foundation --�_i__r-------- Prop. Line _67� -_:--------. <br /> LEACHING LINE No.,of .Lines --------------- Length of each line-------------------- Total Length 14�? -- <br /> ­D' Sox -__ ------- Type Filter Material L fL_____ Depth Filter Material _19__._-___________________________ <br /> l ------------------------/ Property Line <br /> Distance to nearest: Well ____6?�__________- Foundation ____________________ <br /> SEEPAGE PIT [ ] Depth ----- ---------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No <br /> Water Table Depth ------------------------------------------------Rock Sizo -------------------------------- i <br /> Distance tnearest: Well -----------------------'--------_--_j---Foundation -- ----------------- Prop. Line ....•--------_........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ________.__------------------- ----__ -Date°_____________1.__________________) <br /> Septic Tank (Specify Requirements) ---- ------------------------------------------------------------------` ----------------------------- -----:---------•- t <br /> Disposal Field (Specify Requirements) ----------------------'------------------ -------------------------------------------------------------------------------------------- <br /> -------------- --- ------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- <br /> i <br /> -------------------------- ---------------- ------------------------------------------------- <br />� existing-and_required--add+tion-onreverse,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 <br /> icen sed agents signature certifies the following: <br /> "I certify that.;in the performance of the work for which this .permit is issued, 1'shall not employ any person in such manner <br /> as to become"subject to Workma 's Compensation laws ofalifornia." <br /> Signed S Owner <br /> BY -------- Title -------= <br /> --------------------------------- ------------------------ <br /> f (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> s <br /> APPLICATION ACCEPTED BY ------ [ tC' — -------------------------------------------- --------------------- DATE ------ <br /> -- <br /> BUILDING PERMIT ISSUED ------------------ ------------------------------------------ -----------------_----------- DATE --------------------------- --------------- <br /> ADDITIONAL <br /> ------------------------=--------------------- - ------------------------------------------ <br /> ------------- -------------------- ------ --- -- -- -- ---- <br /> --------------------;------------ .. --- - ------ ------------------------------------ <br /> Final Insp �„ g------------ --------- " '� -- --Date -- �_-.� <br /> SAN JOAQUIN LOCAL HEALTH. DISTRICT ' <br /> E. H. 9 �.. 1-'68 Rev. 5M <br />