Laserfiche WebLink
1-UK OF MC:t USt: <br /> "' '��PPLICATION FOR SANITATION PEPW. �,- <br /> ---------•--•- --------- - ---- - L - Permit No. _ f �l_ <br /> 4 (Complete in Triplicate) <br /> -------------------------------- <br /> - Date.Issued <br /> ---F--------------------------------------------------- This Permit Expires 11 Year From Date Issued . <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and inst a wor erein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing RuLandegulations.JOB ADDRESS/LO _ TION/'I?'�](�_--� - �------------------------- -->---•-_----.-----CENSUS --------- <br /> Owner's Name I T,- ---- ---- - - - -- --- --• -----------•-- ----------_.: Phon -------- •-•-- <br /> Address __ � YVI--- City •--------------------------------•------ <br /> �ate' <br /> Contractor's Name ---------- - s -License # [ sP _ Phone _----•---------------------- <br /> FInstallation will serve: Residence [ p rtment House Commercial pTrailer Court ❑ <br /> Motel ❑Other -------•------------------------------------ ,` <br /> Number of living units------ ----- Number of bedrooms _ -if- <br /> ____Garbage Grinder -- ---___ lot Size 41 .......•---------- <br /> Water Supply: Public System and name --------------- - - Private <br /> Character of soil to a depth of 3 feet: Sand'[] Silt.Q ' Clay ( l of ❑ Sandy Laam •[] Clay Loam <br /> Hardpan Adobe" <br /> yes,type ------------••-•-•---------- <br /> i <br /> [�" Q . Fill=Mofio�ial--.-:-.__--_. If <br /> (Plot Ian, showing size of lot, location of.s sterh1h relation .to wells, buildin A,ry I <br /> p 9 ._ Y..,�. ~_..•..�_-..,..__....__.. ..__.__...,.,..._`� _etc:.�must be placed on reverse side.) � <br /> ',..__. \ <br /> NEW INSTALLATION: (Na septic Tank she ge pit permitted i p�blic`sewer ii ilable within 200 feet,} j + <br /> PACKAGE TREATMENT [ ] , SEP 11 !fTANK' <br /> [ Size-419- f-1.0---/-------- ---------- Liquid Depth -- ----------• --- <br /> Capac�tY ^ p ----.a- Type -- Material- a--- No. compartments - -`--•-------- <br /> -stance t4 nearest: Wel! .----------SQ___-___--..-_-•---Foundation ------1-47---------- Prop. Line --S............. <br /> .. � <br /> LEACHING LINE [ No. of.Lin s ------A-----_- Length of each'Ifne------ _�__________ Total Length _____cQ-QLD...._._.-- � <br /> 'D' Box :-_-;__ Type Filfd? Mate'ri'al -_- --- _ Depth Filter Material .----1- ---------_-------'...--------- <br /> Distance o neares+:-4f+f 4f-- �____-- -Fciu idotion ---------JP-------- Property Line ----s. .--- -•---:-•-- <br /> = r � C <br /> SEEPAGE PIT [ Depth ____ :- ______ Diameter Number ____- Rock Filled Yes j No .� <br /> } t ,. <br /> Water Table Depth `- --------------#v-.-------------------Rock Size --------- J , <br /> Distance to nearest: Well ---------------k)P.r--__.__------Foundation ------- Prop. Line --- .......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --••,-------------------------------------- Date ----------------------------------I <br /> SepticTank (Specify Requirements) ------------------•------------------------------------------------------••------- ------------------------------1---------------_---------- <br /> Disposal <br /> ----- ----•---------------,---------•----••--•---------- <br /> Disposal Field (Specify Requirements) --------•!------------------------­----------------------------------------------------------------- -------------------•---••------ <br /> F-- ---------------------------------------------- <br /> ---------------------- ------------------------- ----------•-------------•----------------------•---------------------•--------- -w•-----------•----------•- <br /> -- -------------------------------------------------------------------------------:---------------------------------------------------------- <br /> -------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> ., 1 hereby certify that 1 have prepared this appl cation 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, 1 shall not employ any person in such manner <br /> as to become subject <br /> ` subject kman's Compensatdn laws of California." <br /> rli <br /> fornia." <br /> Signed ------------- ---- ------- --- --�--- ------- • -------- Owner <br /> Title ---- <br /> - -----• ------ <br /> fof <br /> r <br /> er than owner) <br /> FOR .DEPARTMENT USE ONLY <br /> � <br /> APPLICATEON ACCEPTED BY -----�- - -=� - ------ - - --------------------------•---------------------• --•- ----• DATE `--�-- •A---- <br /> -- --------- <br /> BUILDING PERMIT ISSUED _ ---------------------------`---------------------------------------------------------- ------------DATE ------------------------------------------- <br /> ADDITIONAL C_O_._M_._M_E.N_T..S. --------- -- - ----------- --------_---- - <br /> - <br /> ----- - ._. <br /> t --------------------------------------------------------------------------------------------------- •------------------•---------------•-•---------••------__---- i <br /> _ --------- -------------------- --_----- ---------- - ... <br /> --- <br /> ___ _ _ �__ ____' - �.__ _:__ D I <br /> Final Inspection by: .�� ...-....- - '-----------------s ate <br /> r; _. . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M ; <br /> J <br />