Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> v <br /> -------- ----- - Permit Na". 70-�1 <br /> --- - ----------- <br /> i <br /> (Complete in Triplicate) <br /> -y Date Issued ,2z---.2- 7+!J <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 <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION -Q"!:� -c —----------------------------------------.-CENSUS TRACT -------------------------- <br /> Owner's Name ---------------------- -------------•---------------- -------Phone � '-- � <br /> Address � � "" �^ ------- ---------------------- City / ------ ----------------- <br /> Contractor's Name - __u� 7' �'-` !- License # - a:` .lj--- Phone _04' �- <br /> L7- <br /> Installation will serve: Residence;&Apartment House-[] Commercial []Trailer Court ;❑ <br /> Motel ❑ Other -----r-------------------------------------- <br /> Number of living units:..--. ----- Number of bedrooms -__-/-----Garbage Grinder ------------ Lot Size -')` ------------ <br /> I ] -------- <br /> Water Supply: Public System and name - ---_�f1" r ------------------------------------------------------------------------Private ❑ <br /> V. <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 12� <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 -------------------------. l <br /> Capacity - ------------------ Type -------------------- Material------- No. Compartments --------------•-•----- W <br /> Distance to nearest: Well -------------------------__--------Foundation ---------------------- Prop. Line -_----------------_ <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each Fine-------.---------- ------ Total Length <br /> 'D' Box --- -------- Type Filter Material -------_-_--------_Depth Filter Material -------------- - <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line --------.--------....... <br /> SEEPAGE PIT [ ) Depth -------------------- Diameter ---------------- Number ---------------------------- Mock Filled Yes [] No i❑ <br /> WaterTable Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -.-------_.._-_---__- <br /> *WAIR/AMTION(Prev. Sanitation Permit# -------------------------------------------- Date ---------.----.. _---_--_-------) <br /> SepticTank (Specify Requirements) - ----- ---------------------------------------------------------------------- -----------------•--- ------ --,..--------------------------- <br /> Disposal Field {Specify Requirements) # --- p-r� =' ----- <br /> r� s- <br /> -aozz----C/, - �.1_ " -- ------------------ <br /> ----------------------------- ---------------------------------------- ------------------------------- ------ ---------- --------------------------------------------------------------------- <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 <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. dome owner or licen- <br /> sed agents signature certifies tate 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 <br /> as to bec a subject to Workman's Compensa ion laws of California." <br /> Signed - - - ---_�-- -`��-�--�p ---- Owner <br /> BY � ---------------------------------------------------- Title -------------------- <br /> -------------------- <br /> { <br /> If other than owner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ------- ----- ---------------------------------------------------------- <br /> DATE -- .-�--� ---� �---------- <br /> BUILDING PERMIT ISSUED -------- -------------------------------------------------------------- -------------------------------- DATE --------------------------- <br /> ------------------------------------------ --------------- <br /> ADDITIONALCOMMENTS ------------- ---- ----------------------------------------------------------------------- ---'---------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---- --- -- ------------------ 1 <br /> ------- ----------------------------------------------- --- -------------------------------- --- ------- ---- - <br /> ------------------------------------ - ' <br /> Final Inspection b Date --____- 1 I 7-$.-..-.---- -_ <br /> - - --------- - -- ----- <br /> p Y = --- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />