Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. 7�!73 <br /> ... ............................................ (Complete in Triplicate) <br /> ................................. <br /> - Date Issued 3..4'1......... <br /> This Permit Expires 1 Year From Date Issued <br />...................................................... ., <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 /> �!l� CENSUS TRACT ..� --------- <br /> Owner's <br /> ADDRESS/LOCA ION -.4•x.- -- .• _�•,Q,,�,f).�•�r •••--••CE U <br /> Owner's Name _ 1� (cS......._ C?al� ....................:......v.............. e ..................................... <br /> -•:-,- Phon <br /> .s City,-- ,�,,// <br /> __-. - _0i<VF_..... <br /> Address _..�.�.Qlp-�1-._...�hl:.alokl .UL� .------�•--••-- ••-•• Ph--------• ---... <br /> License #.�c1,".7..2!_.._ one. .. _.. .- <br /> Contractor's Name ..�••--• -- � -• � - i <br /> Installation will serve: Residence 0-A15artment House Commercial Trailer Court <br /> Motel []Other .....................::..:. .:... <br /> Number of 1ivirtg'units:__...-. Number-of-bedrooms .. >: geGrinder ,...._ Lot.Size _.... <br /> Gprba ,._ -- — PrivateT �.. <br /> Water Supply: Public System and name ---- ------------ .......••.-'--------.-----------....-•---- ..................... <br /> _......_.. <br /> Peat Sand Loam Cloy Loam <br /> Character of soil to a depth of 3 feet: Sand'[J . Silt❑ Clay ❑ �] Y fl Y 0 <br /> Hardpan Adobe:g?,--Fiil Material ............ If yes,type ---------------------------- <br /> (Plot plan, sFto�ize of loQocatiori ofj3 stem in relation,"to=wells,.buildings, etc. must be .plated on reverse side.} <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if.public sewer is available within-200 feet,) <br /> PACKAGE TREATMENT [ ] SEPT]C TANK ] \ Siz®-----....................-......-........ Liquid Dept <br /> -----......-•-----........ <br /> ...NT <br /> _':_ Material No. Comport <br /> Distance me`i s ..............•..•. ... <br /> . <br /> i - Capacity .. ................ Type .... ...,_ �s <br /> a #o,nearest.-Well .......... .......' .`.�. .`. 0 <br /> :..-Foundation ...---•..._.-•----•-•- Prop. ......................• . . <br /> LEACHING LINE [ ] ' No. of Lines ..........-----------{... Length—of—each Ilse._.-------------­--------.-. Total Length ........................ 6 <br /> � <br /> 'Filter Material -'Depth ..Filter`Material .................. ...... <br /> 'D"Box .__-______._ Type ........... <br /> _ <br /> Distance to nearest: Well .::.......:... ......... Foundation ................... __."Property Line -------­--­-­- <br /> ' <br /> --._..-•-- <br /> SEEPAGE PIT 17 Depth �.. :...........:. Diameter __.....-__.-_... Number ................ ':.'�_•:.:.. Rock}Filled Yes �] No Q <br /> • Wate:r`Table Depth ...........:........Rock Size -•.............................. <br /> ' Foundation .. Prop. Line .................•- <br /> Distance to nearest•.Weii ---•••-----•• ----••-------- <br /> REPAIR/ADDITION Prev. Sanitation Permit�# DateT..:.:: -• -- ----- <br /> �... <br /> _...-_.....- <br /> Septic Tank (Specify Requirements) _----------------•- -�•:--'---.......---------_.. - <br /> � Disposal Fie)d (Specify Requirement 1 --••------- <br /> e. . .��u ...... ..�-•M-p ..... <br /> ••--••-••---------------•---•----.----------- <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 San Joaquin <br /> i County Ordinances, State Lawn 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, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -. er <br /> •__--- Own <br /> N C A <br /> I <br /> ......... Title <br /> BY ----- --•••--------•--.._...---•-- <br /> {If other than ownerj <br /> FOR DEPARTMENT USE ONLY "• . <br /> APPLICATION ACCEPTED BY _._. . -.`..... ..:.... .... ...........•_................... .__...........•---'- ..........�:.. DATE .. '_f~.....:............ <br /> BUILDING PERMIT ISSUED ••••-:....:...............:...... DATE _......:::_..:....:...._... •..._.:_.__:. <br /> ......................... . <br /> ADDITIONAL COMMENTS .------••--•••-- <br /> -•...............................•....._......••------........._---:__..---••---------- ..........7- ;. •.....;: <br /> _. ....................... <br /> ------- <br /> - - -------------------------- <br /> .....---....... <br /> Final Inspection by: - <br /> ... Date ..7... - <br /> 'A.` <br /> SAN JOAQUIN :LOCAL' HEALTH DISTRICT „ . <br /> '44 7172 3 ,K <br /> 13 24 1_•Aa P. j;Nl <br />