Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete In Triplicate)) Permit No. <br /> ..... <br /> ..... <br /> ................. <br /> .......I......... ............I....... ........... This.Portnit Expires I Year From Date Issued Date issued <br /> sApplication 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 Ordlnariie'No. 3d9 in-d i-xi-sting—Rules and Regulations= <br /> JOB ADDRESSAOCATIO ... ........... ......... ..........CENSUS TRACT .... .................... <br /> 0 ........ 2- <br /> Owner's Name ......... 4,f*-,4. ..... ?COI.......................... ......:.......... ......... .... ..Phone 4/6 .-477!�.......... <br /> Address ........ 14�z(.7. <br /> ...... - *.. ...... ./_)_ 7_ WA. "�aO_..........-....city ...... ........ .......... <br /> Contractor's Name ...... ........ . .... .......__........License # .... phone <br /> Installation will serve: —ResidenceViApartmentmousis 0 commercial [3Troller Court C) <br /> Motel0 Other............................................ <br /> Number of living units:..... N6mber of bedroo;W__ <br /> ../.....Garbage..Garbage Grinder .... Lot Size :..... A <br /> name ......-----.---------•--•--•---..-_ ......_..........__........................ ...................Private 0 <br /> W?ter Supply: Public System and I <br /> Character of soil to ci`cle'0�th of 3 feet- Sand 0 Silt❑ CIOY 0 Pact 0 Sandy Loom 0 .Clay Loom 0 <br /> Hardpan 0 Adob Fill M6t&riat ...... .....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 ovailliable within 200 feet,) <br /> .PACKAGE TREATMENT f ] SEPTICTANK Size.-..................�'_:.................... Liquid Depth ....... ................. <br /> Capacity ................... Type .....................Material_............... No. Compartments ...................... <br /> Distance. to nearest: Well ..... <br /> ...... ..........Foundation ...................... Prop. Line ............. <br /> LEACHING LINENo. of Lines ... ...... ........ <br /> _.__._Ljngth of each line............................ Total Length ............................ <br /> 'D' Box <br /> ..... . Type Filter Material ....................Depth Filter Material ............................................ <br /> -Distance to nearest: Well ............ ........... Foundation ........................ Property Line ......................7 <br /> *SEEPAGE PIT O Depth ........ - Rock Filled 5 [3 00 <br /> Diameter .... ....... Number ---------------------- - oc Yo N <br /> Water Table Depth :............................................Rock Size ................................ <br /> Distance to,nearest; Well ........................................Foundation ........ ..... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitationt Permit# ........... -- ----- Date •.._-_.---.................... <br /> Septic (Specify Requirements) ..............Jd------- ... ... . <br /> . <br /> 1 0,1_X.2 1.1-.... - <br /> ents) --. ...--fir 1 ... . ..... ....._4 <br /> .... <br /> Disposal Field (Specify Requirements) ­­­-------­------------­I... . ........... <br /> ...................... ............ ............ ----_------------­ ...... ................... ....... ........................ .................................... <br /> ..................I.................................. <br /> ---------- ........... ........... ......................... ................................­......­­­....... ...... <br /> lDraw 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 Health,01strict. Herne owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance-of the work for which this Permtt Is issued, I shall not employ any person In such manner <br /> as to become subject to Workman'$' Compensation laws of California.,, <br /> Signed ............. <br /> .... .. . .. ............_................ Owner Jk <br /> By .............../�' <br /> . . . .................. ................. Title C-p—rh........ ... <br /> ..... ........-......................... <br /> 1 he t r owner) <br /> ,FOR DEPARTMENT USE ONLY <br /> 101:1-A <br /> APPLICATION ACCEPTED By---;-7_5 - ----- ---- ---- <br /> . .......... .......7DATE-04��Z�_.- ....... <br /> /.Z, <br /> BUILDING PERMIT ISSUED ..... <br /> /......................... ..... .. ---------------------- ------- <br /> ADDITIONAL COMMENTS <br /> ................... ........... ------------ ..... ....... ....... ....._.-_.`DATE..............--,........-.....-....._....... ... <br /> ................... ........ ............ .......................... - - ---- --- ------ - -- - --- <br /> -------------­­_-------I.................. ....... , - <br /> ......................................... ........ <br /> -------------------------- <br /> ............. ----*..............*---------------*--------­-------- -- ------ --- ------*- - ---- - ------ <br /> inal Inspection by: ......................eA­w.......... ......................... ...... ................�Date ..... <br /> Ell 13 2h 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />