Laserfiche WebLink
FOR OFFICE USE: <br /> ,r3 0 s APPLICATION FOR SANITATION PERMIT /� 'Z� <br /> ------------- ---` -------- - ------ _---` Permit No. _fU =S <br /> T 1 (Complete in Triplicate) <br /> -------------------------------------- ----------- <br /> ► Date Issued 7:n/ � <br /> ----------- This Permit Expires 1 Year From Date Issued <br /> Application is herebytma�e to the San Joaquin Local Health District for a per 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 /> - j <br /> JOB ADDRESS/LOCATIO 3_ --- "`� } ----- - -----------------------------------CENSUS TRACT ---------------__--- <br /> ---- <br /> l-1_ _ ------ <br /> Owner's Name ----------1--���------------------ -------------------- --------------- ---Phone <br /> - -------- ----- <br /> Address ----+ --------------------------------------------------- <br /> 16-4--- !T ----- City <br /> Contractor's Name f-- " PHorie ------------ --•---- <br /> -- ----- <br /> Installation will serve: Residence partment House-E] Commercial ❑Trailer Court ''0 r <br /> C ! Motel E]Other ---- --------------------- -------- -�-- r� <br /> Number of living ;un its:------ Number of bedrooms --__ <br /> �--..Garbage Grinder _____._.____ tot Size <br /> Water Supply: Public System and name .-------------------------------------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: SandE] Silt❑ Clay ❑ Peat❑ Sandy Loam .E] Clay Loam_[R <br /> f <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![ ] Size------------------------------------------------ Liquid Depth -------------.--------- <br /> t <br /> Capacity -------------------- Type --------------- Material---------- ---------- No. Compartments ................... <br /> Distance to nearest:. Well ------------------------------------Foundation ---------------------- Prop. Line ---------------__-_-._ <br /> a <br /> LEACHING LINE [ ] No. of Lines _.------------------ Length of each line---------.-------------.__._ Total Length -----------.-_----_---_-__-_ <br /> 'D' Box .----------- Type Filter Material --------------------Depth Filter Material _ _ _- _ _._-----__ <br /> )f Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ---_-_-_........_.._..-- <br /> SEEPAGEYIT� [ ] Depth ---- -- ---- ---- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------=--=--------Foundation _-.--------------------- Prop. Line --------------- ------ <br /> ---------------------- <br /> REPAIR -------------------':pate --� -----__-) <br /> REPAIR/ADDITION(Prev. Sanitation Permit# __.__.__._________ ---__. ------- <br /> Septic <br /> Septic Tank (SpecifyRequi�.-ements) __--- \ <br /> i { <br /> Dis osal, Field SS eci fY Requirements)(e'�� _- / <br /> r- --- <br /> -----------I-- I D- -------- ---- _ --------------------- ----------- --= <br /> { T---- ------ --- _`- ---- -- --- --- <br /> -? �Faw.existing*and required. <br /> { j 1�( q clition on reverse side) <br /> I hereby certify that-1-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 ceVy 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 /> E <br /> Signed --------- _ ----------------- ---------- ---------------------------------------- Owner <br /> BY -I----ll- ----- ---------- ----- tJ' -- ------------ Title <br /> ------ -------------------------------- --------------- <br /> j] (if other than owner) <br /> f ! <br /> FOR .DEPARTENT USE ONLY - <br /> APPLICATION ACCEPTED B ------ ------------------------------------- ---------`------. DATE --- <br /> --------------- <br /> BUILDINGPERMIT ISSUED --------------------------------------------- ------------------------------------------------------------DATE -------------•----------------------------- <br /> ADDITIONALCOMMENTS -------------------------------- ---------------------1----------------------------------------------------------•----- •-------•------------------ <br /> ---------- --------------------- - - <br /> ------------------------------------------------ --------- ------------------------ -------------------- -- - - --------------- --- <br /> - _ ------- ------- <br /> Final Inspection by: -------- _ -- -----.Date --- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br /> I <br />