Laserfiche WebLink
t FOR OFFICE USE: APPLICATIQ.N FOR-SANITATION PERMIT FOR OFFICE USE <br /> -•------------•------------- -------- _____ _ _ <br /> (Complete in Triplicate) Permit No..71-.5_:0 . <br /> ------------------------------------ ............ -- Date Issued... <br /> ................................. ................ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 49 and existing Rules and Regulations; <br /> JOB ADDRESS/LOCATION. _ - .-:!"-I.- _ <br /> ..-----•----------------------- - ----CENSUS TRACT. --------------------------- <br /> Owner's <br /> -- ---- -------- --Owner's Name....... . - Phone..-------•-;•---- ------- ---- <br /> Address----------- -- Cit Zi <br /> - ----- Y ---------- ----- p---=---------------------- <br /> Cantractor's Name...... ]�f --- - ............................License 0-0 <br /> _V__�- 1 --.-Phone. <br /> Installation will serve: 11 Residence Apartment House ❑ - Commercial ❑ Trailer Court ❑ <br /> otel ❑ Other-.................... . -----------..._.. <br /> Number of living units:.........:......Number of bedrooms_. _..:....Garbage Grinder.-..........Lot Size............... - ___-.--- >.-_.....__.. __ .. .. <br /> Water Supply: Public System and name...... . --r _..._....._.__..................__..:---:.:....-------._..._. Private ❑r <br /> Character of soil to a depth of 3 feet: Sand-E] Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan p ❑, Adobe ❑ Fill Material.. ....,- ..If yes, type-------------------------------- <br /> [Plot plan, showing size sof lot,-location of system in relation to wells, buildings, etc. must be placed on reverse side.] <br /> t 3 <br /> NEW INSTALLATION: [No septic tank orz�seepage pit permitted if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT [ ] .. SEPTIC TANK ---------------------------------------------------------Liquid Depth-------- -------------- <br /> Capacity...... - ---. --_.Type_.... ....... .........Material--------- --•--• --------No. Compartments....---• ------ - <br /> Distance to nearest: Well---------------------------- -------.-.-...Foundation ......... - --- -. -. ..Prop. Line----_-_-....- --------- <br /> i LEACHING LINE [ ] No. of Lines .._ ...._ .Length of each lino------------------------------Total Length . <br /> D' Box..., Type Filter Material..-. ...... ...Depth Filter Material......................---.-. <br /> Distance to nearest: Well---..........................Foundation-------------.__.------_ -.--Property Line...................--............... <br /> i <br /> SEEPAGE PIT [ ] Depth................Diameter.--i-------­--------Number-----------------------_------_ Rock Filled Yes ❑ No❑ <br /> WaterTable Depth------------------------------------- - ---------------Rock Size.- -- ------------------- ....... <br /> Distance to nearest: Well----------- --_--- - ------- ---------. Foundation_...... _------- _ .- Prop. Line------............. <br /> REPAIR/ADDITION (Prev. Sanitation Permit#........................_........_.. ........_......Date.........:----------------.--._..--. ----.-----} <br /> Septic Tank (Specify Requirements)..__. -- . :................................ Y. <br /> ,Disposal Field (Specify Re uirementsl..- - ----- --- - --- - -- . -- <br /> n - ----- <br /> {Draw existing and required addition on reverse side] <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents; <br /> 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 as <br /> to become subject to Workman's Compensation laws of California." <br /> Signed. -------- -- -------------------------------- ----------------Owner <br /> By. e � ti l--✓1r�g�Ker <br /> . ------------------ --Title-----...---Of other than o <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- .._ "-` ------------------ -DATE ... <br /> DIVISION OF LAND NUMBER --------------------....__..DATE--.......---_.... <br /> ....... ----- <br /> i <br /> ADDITIONALCOMMENTS----------- --------------------- --- ------I----.-........._...... ---•.-_------- ...------- .---...__..__.._....... <br /> ..................... .... ... . ................... ---- .---- - ------..------.------...... ---------.-----......--- ---- --.---- ...---- .----..... <br /> ---------- ..... ------ . ......... <br /> ------------------ ----- --- ----- ----- <br /> Final Inspection b ... --- --------- - -••----------------------• .............I.---...-- ••........ --..Date......- 2.`7/FZ21 <br /> .x' <br /> Y <br /> EH 13 24 S JOAQUIN LOCAL HEALTH DISTRICT 677 REVr7/74 3M <br />