Laserfiche WebLink
MR OFFICE USE APPLICATION FOR SANITATION PERM <br /> (Complete In Triplicate) <br /> Permit No. . �-655 <br />......................................................... Thls Perm1F 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 heroin <br /> described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulationse <br /> JOB ADDRESS/LOC TION .. ...��.�::4. i�.�sral:�......�t�r1c�....................................CENSUS TRACT . <br /> Owner's Name .. . V. ►.f-:..... . c. a t........................................ ................. ...............Phone .�&:�621.�a?:.......... <br /> Address .............../.(.,.i_ .._....t��a.�.: ... . sec ..... ............City ...�SA4 174?,t..................................................... <br /> ..... _ <br /> Contractor's Namef f License LPhone <br /> ---•--...C,e.cr- = ci ..........��nrr.; . ......... <br /> Installation will serves. Residence P,Apartment House Commercial OTraller Court 0 <br /> Motel❑Other........................................... <br /> Number of living units:.....f.... Number of bedrooms ......Garbage Grinder ...Ae1- Lot Size .... ...1 C!'.:...........:.......... F <br /> Water Supply: Public System and name ......................... .:._--------............_....._._..---•----------.....:..--•-•--...........Private <br /> Character of soil to a depth of 3 feet: . Sand❑ Silt[3 •-Clay E3 Peat <br /> Q Sandy Loam 0 Clay Loamy <br /> Hardpan❑ AdobeC) FIII Material .......--... if yes,type ........... ............ <br /> $Piot plan, showing size of lot, location of system In relation to wells, buildings, etc. must`be placed on reverse aide.# <br /> NEW iNSTALLATIONs (No septic tank or seepage pit permitted if .public sewer is avallabte within 200 feet,) ; <br /> PACKAGE TREATMENT ( I SEPTIC TANK( Size...... ......... Liquid Depth ........................ <br /> Capacity Type e t�-A cMaterial...6�C{ No. Compartments . .tTP............. <br /> Distance to nearest: Well- ..AQQ.".....................Foundation .��.....-_..... Prop. Line 4� 4e'' ,: f� <br /> .. .,.........------ <br /> .. <br /> LEACHING LINE [ ) No. of lines ..........c�.-------- Length of such line...:�!%.�............. Total Length :................ � <br /> 'D' Sox __/------- Type Filter Materia! r _r. ..Depth Filter Material ...., ......................... ... i <br /> Distance to neoreste Well ';1�C�: <br /> foundation^ ................ Property Llns . ` :... .. j <br /> SEEPAGE PIT I # Depth ...... ............. Diameter ................ Number ............................ Rack Filled Yes ❑ No <br /> Water Table Depth ................................................Rock Size ................................. ' <br /> Distance to#nearest: Well-........... ... ...... ..............Foundation --.................. Prop. line .. ................ <br /> REPAIR ADDITION Prev. Sanitation Permit ... Date ..I <br /> SepticTank (Specify Requirements) ......................................... ............................................... ._........_............._................ <br /> DisposalField (Specify Requirements) ...........................................................................................•..............................I........... <br /> ................................ <br /> ................---------._..._.............._._.. ................. .. <br /> ..................-•---------•.......................... .........•..... <br /> .............I._....J......................---------------•--...-----•----•.......... --•---•------•------ ...... -•----•........................................................................ <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this applications and that the work will be dome In accordance with San Joaquin <br /> County Ordinances, State,Laws, acid Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- <br /> sed agents signature certifies the 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 become subject to Workman's Compensation laws of California." <br /> Signed ............... .....- --• -----:------- ........ wren <br /> v4 <br /> O <br /> by ............. . ! '� %. ....._............. Title ._.._...............-----......._... ....................._............. <br /> f (if other than owner) � <br /> FOR DEPARTMENT USE ONLY <br /> `.�.. 6 <br /> APPLICATION ACCEPTED 6Y --- ........,....................................................... DATE ......:.............. <br /> BUILDING PERMIT ISSUED <br /> ........-•--�--•.....:.............................................................................._.....DATE ....------......... ...................... <br /> ADDITIONAL COMMENTS .........:........ <br />• <br /> ................................I...---. ...._....... _..-..�. .... ........_._.._...----• --.......-- "....... ...-------:............. ..._ ...._... �.` 6 .�-7. .._..._......._..._ <br /> ---- <br /> Final Inspection by: ... _ ..._..I.................. --•- <br /> Date <br /> EH 13 2h 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3H <br />