Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />------...•...... ....:.....1- -... Permit No. .7.7"-�/ . <br /> IComplete in Triplicate! <br />.............. ............................ <br />-........... .......... ...................... This Pennit Expires 1 Year From bate Issued <br /> Date Issued ../-a?.�-`T7 <br /> _-. <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 /> 4U M <br /> .IOB ADDRES /LOCATION 4%Yl k-rr..-. �.../��...�^.....GSJ�Ga��c-�C� ......... <br /> CENSUS TRACT ........ <br /> Owner's Name . . ....... .....Phone ..... ... ..... <br /> r�_. <<,�-.-.� ............ ............ ...... ............... <br /> AddressG71 f1:.. .... . ...Z. ........ ........ ..................... ............... city .?G` -.. ...o.................. .......... <br /> Contractor's Name ..License # l,Yy3 �.... Phone .............................. <br /> Installation will serve: Residence(Apartment House 0 Commercial❑Tra€ter Court 0 <br /> Motel ❑Other ............................................ <br /> Number of living units:......I.... Number of bedrooms ..........Garbage Grinder ............ Lot Size . .. .......... ......-•••••. ...... <br /> Water Supply: Public System and name ..Private Er— <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay 0 Peat❑ Sandy Loam{] Clay Loam ❑ <br /> Hardpan❑ Adobe 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 seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ } SEPTIC TANK f Size .................. Liquid Depth ... .......... <br /> Capacity -V0.J)_ ._ Type -<'- Material.................... . No. Compartments <br /> Distance to nearest: Well ----- ...................Foundation .... d4.4". ..... Prop. Line ...g ......... <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line.----------•................ Total Length ............................ <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material .._..................... ................... <br /> ? � Distance to nearest, Well ........................ Foundation _....................... Property Line ........................ <br /> Depth ----- ------ Maw~ Number ............ .............. Rock Filled Yes No i❑ <br /> Water Table Depth ............:S1:-t....... ..........Rock Size ------------------ <br /> Distance to nearest: Well --------r!P-Jnt...................foundation ---- Prop. Line .........� <br /> REPAIR/ADDITION.(Prev. Sanitation Permit# -------------------------------------------- -----...---........... <br /> . _ Date ..._........ } <br /> SeDisposal <br /> Tank (Specify Requirements) ---------------- ------------------------....................................................................................------------- <br /> Field (Specify Requirements) ...P,, �• --� �°�.....-•-- <br /> G �v- Q -----•--•- <br /> -----------------—1-------------------- ---------------------------------------.............-----------------------........................._................I....... <br /> . <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 shalt not employ any person in such manner <br /> i as to become subject to Workman's Compensation laws of California." <br /> Signed ---- ----------------------------- Owner <br /> Title "� <br /> BY -�`'�-r` -- <br /> (if other than owner) <br /> FOR EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ -- ----- --- -- •-------------- --------------------- <br /> --------------- ---_.... DATE .. .. .. .. ..f7 ..:------: <br /> BUILDING PERMIT ISSUED ---------- ----------------------- --------•--.........---.-----------...---------. ------.....---DATE ................................... -•--•- <br /> ADDITIONALCOMMENTS •--•.............................••--•-•-----•-•--- .......................... ---------.............. ------------------------------- ........I--------------- <br /> ---------------------*----------------------------------------------------------------------^—---------------*..............*----------------- <br /> -------------- <br /> ------------------- -•--------------------------------------------•-•----•--...--•--.....--•..------•---._......._..._....---•------------•---- --•------- <br /> .------------ <br /> .................................. <br /> ........I..................... <br /> Final Inspection b -----.---. �.. <br /> P Y= ------------ .. -• ----- �:._----...--------...---•-----•----••-..----•_,..._...----•-Date ...../."'......---•--..'�'�.-...---•- <br /> EH 13 2!t 1-68 IL-v. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />