Laserfiche WebLink
' FOR OFFICE USE: <br /> ............. APPLICATION FOR SANITATION PERMIT <br /> (Complete in triplicate) Permit No. .77,.^.3�'J <br /> ...... This Permit Expires 1 Year From Date Issued Date Issued <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 Regulation , <br /> t <br /> JOS ADDRESS LOCATION pVJ <br /> p <br /> / -- -------- ...... ,. CENSUS TRACT <br /> Owner's Name ................... <br /> 5 .._...._..__._...... <br /> -- ............................................ <br /> Address hone $.......--•- <br /> • en �, <br /> $- 5$ <br />� 3 <br /> n p <br /> j Contractor's Name _..__: ._( ,.'P..t :terc. _r�._ S�nf =a�5cLicense, <br /> ... <br /> ......... ense ��_` <br /> 'Installation will serve: Residence aApaftment House i] CornmerciaTrailerxCourt <br /> Motel ❑Other <br /> Number of living units:.---)._.--- Number of bedrooms .3:..-.-Garbo a Grinder .._.._.___-. <br /> g Lot Size J-6p---K.3��-..--•-••--- <br /> Water Supply. Public System and name ................ .......... . <br /> _ -..... ------------- Private <br /> r .... -.,�.F.•��;,r- -��..=ems .�� .............................. 17Q <br /> Character of sail to a depth of 3 feet: Sand Silt[] Cl y Peat "Sand' Loam` X <br /> ( .,._ :D �._ n y ❑"=Clay Lociin-] — <br /> Hardpan ❑ Adobe [j Fill Material ------- If yes, type ......................... <br /> (Plot plan, showing size of lot, location of. system in relation to wells, buildings,�et`C must be placed on reverse side.) v� <br /> NEW INSTALLATION: t d <br /> {No septic tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT ( ) SEPTICrTANK <br /> Siae....__f--- <br /> �. ................. Liquid Depth <br /> Capacity .T ?4 Type - z:C' s�.. Material----.c+uc--- <br /> t No. Compartments 5??._.... . <br /> . . ......... <br /> Distance to:nearest: Well .... - p r <br /> _.•.____--..Foundation ._..(... ........... Prop. Line .-�.-�------••--• <br /> LEACHING LINE No. of LinesF' <br /> -------------- -Length of each line.----- :I'f;�.`----....•_ Total Length Vqfl�- <br /> 'D' Box .__J�..`_..._ Type Filter Material .:�__. ... <br /> �= ,. <br /> � ...._Depth;Filter Material .../8................................... <br /> Distance to nearest:'Well X15. , r. :... Foundation-------- <br /> --_Cr'F ' <br /> -- �....:..:...... Property Line (._J-�....:--- ' <br /> SEEPAGE PIT Depth '........�__...... Diameter ......fa` Number _'.A---_------------ Rock Filled Yes � No Q <br /> ..- <br /> Water Table I Depth 5' <br /> 1 r'-Z <br /> ...._ ...........Rock Size <br /> _ <br /> Distance to nearest: Well ... 4.... Foundation -----to-�-r`_-... Prop. Line ..`-�.. ---------- <br /> REPAIR/ADDITION{Prev. Sanitation Permit+# -------------- ---_.- Date ......................... <br /> Septic Tank (Specify Requirements) ................................... <br /> ............ <br /> Disposal Field (Specify Requirem :..:.._ <br /> .. . _ .. E <br /> ents } ___________ __ _ ------------­----- <br /> --...-•_....... •......_..... ......... <br /> ­,&.,:a - <br /> ------------ <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 Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Healli 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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ....---- •--•- Owne. <br /> By �. _ __.. _ _..... <br /> -• Title .. ._.- <br /> (if other than owner} . <br /> - <br /> FO R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY:.... . .............. --'-"".................................. DATE _.4`..'.a-. .�1 ............. <br /> BUILDING PERMIT ISSUED ...................... <br /> ----••-•---------------------------------------------------------•......-----......DATE ..........•••......---- <br /> ADDiTIONAL COMMENTS .....:............... - •••---------••••• <br /> .....-----•---••------------•...................................... ........ <br /> ....................... ..•.. t_.:_.. -- <br /> Final Inspection by: ... -••----- ................ = .................. <br /> .._....---•-----.. <br /> _ __ -- ......... ..........Date r,�_' .". .� <br /> --------------- <br /> SAN JOAQUIN LOCAL' HEALTH DISTRICT µr <br /> E. H.13 24 1.'68 Rev. 5M <br />