Laserfiche WebLink
FOR OFFICE USE: � <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------- Permit No.77___-` W <br /> (Complete in Triplicate) <br /> Date Issued J <br /> _ ` <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 ___ -_ 71 L- -. ���` _v -'CENSUS-TRACT""""'-----_-.-:._____ <br /> "r7► -- <br /> Owner's Name ------------------------------- -- - =---------------- -- - pho <br /> Address ------------------------ -_. City � �- = <br /> Contractor's Name ------------------- -------------------------- --------------------/ ----.License # ------- ------ Phone ----------------------------- <br /> Installation will serve: Residence Apartment House,❑„Commercial []Trailer Court ;❑ ' <br /> Motel ❑Other ------------:--------- ---------------- <br /> Number of living units------------- Number of bedrooms ______Garbage Grinder ------------ Lot Size ------------------------------------ <br /> Water Supply: Public System and name ---------------------------�--......---------- -------------------------------------------------------------.Private <br /> 3 <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑j Clay F-1Peat❑ Sandy Loam ❑ Clay Loam <br /> _. Hardpan VAdobe ❑ Fill Material ------------ If yes,type---------------------------- <br /> f <br /> ------------------------ - - <br /> (Plot plan, showing size of lot, 2taonk <br /> tion of-system in relation to wells, buildings, .etc. must be placed on reverse side.) <br /> NEW INSTALLATION. (No se or seepage.„pit-permitted if public sewer is available within 200 feet,) ' <br /> PACKAGE TREATMENT SEPTIC TANK![ I Size---- -- ------------ Liquid Depth -------_------------.....-_ <br /> Capacity 4, epe _ Materia --- ---- ----------- No. Compartments __ ------------ <br /> Distance to nearest: Weld_/_40;� _______Foundation 0Wy------ Prop. Line .0 <br /> LEACHING LINE [ ] No. of Lines ----- >-__ Length of each line------7_ .. ----- Total Length <br /> 'D' Box _ ____ Type Filter Material Depth Filter aterial -cQ#-.___________ <br /> ...t, <br /> Distance to nearest.'Well/ I° Foundation _T-S -_ ___k_______ Property Line <br /> SEEPAGE PIT [ ] Depth IQ5W_�t Diameter -- Number __._3------------------- Rock Filled Yes No 0 ” <br /> Water Table Depth'----G`f -.�----------------- •--------Rock Size ----/----P6------ <br /> Distanceto needre't,Well�`�_i_ _ _ f__________________Foundation�� ------- Prop. Line lj ..... <br /> REPAIR/ADDITION(Prev. Sanitation Perm t# ---•---.---------�- ----------------------- Date -----------------------------___--1 A <br /> Septic Tank (Specify�Requirements) ----1----------------- -- } - ----------------------------- ---- 1 <br /> f ---------------------------- --- ------- ----•---------- <br /> Disposal Field (SpecifY,�e.�uirements) ---•------------------ ---------------------------------------------------------------------------------------- ---•----------- <br /> ----------------------------------i:, --------------------------------------------- -------------------------------------- -------------------------- <br /> - I----------------------------- --------------------------------------------------------------------------- � <br /> -. ^ ` <br /> (Draw existing and required addition on reverse side) <br /> — - _ <br /> 1 hereby certify that I have prepared tthis application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulat(ons•cif the San Joaquin Local Health District. Home owner or licen- <br /> sed agents##nature certifies the following: <br /> "I certify thaf n the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as fo beco ubject to Workman's rq4mpensation laws of California. <br /> SigncKr------ ------2 ------ - ------ _• ---------------- Owner <br /> °BY ----- ----------------------------------- 3-------------------- --------------- Title ---------------------------------------------------------- ------------ <br /> (if other than owner)4,_/ <br /> FOR'DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY T ----------- - DATE _ S_ '. a ��; ---------- <br /> BUILDING PERMIT ISSUED -----:. _ ---------------------' '----------------------------------------------- ---------------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS .-.--- '� -------------- ------------------------------------ ------------------------------------ -----=----------•---------------- <br /> -------------------------------------------------"-_-- ------------------------------------------------------------- - ------------------------------------------------------------ --------------------- <br /> ------------- -� <br /> _ _ ;_ -_ _ <br /> -- --- - -- <br /> ;Oe <br /> Final Inspection by --- ------ ------- Dated <br /> i SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 4 <br /> ' 'E. H. 9 1-'68 Rev. 5M <br />