Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. _7/:.� '6 <br /> (Complete in Triplicate) <br />......................................................... <br /> This Permit 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 herein <br /> described. This application is rnol"3ognplionce with County Ordinance No. 544 and existing Rules and Regulations: i <br /> JOB ADDRESS/LOCATION ..... ,._.JYj1P,� l.S/.-----fid ....................................CENSUS TRACT ..................._...... t <br /> Owner's Name ..__ /�/�-•....�/�t1.M. ..........................,.......--------=. ...................Phone ...................---.............. <br /> `_V/A ---......)C.l. /PIUr,�'ll .� �?.�.�.1�:-"t"-T-�•Tity .. f��r .�sz + �/ ........................ <br /> Address ............. <br /> Contractor's Name .._. License # Phone .............................. <br /> Installation will serve: Residence [4 Apartment House-❑ Commercial ❑Trailer Court i❑ ; <br /> Motel ❑Other ...........................---------------- _ <br /> Number of living units:.... ...... Number of bedrooms ----/-----Garbage Grinder ... Lot Size .............. <br /> Water Supply: Public System and name ------•---- ...................--------------------------.....................................................Private ❑ l <br />—..-Character of soil to a depth of 3 feet:_Sand ( Silt❑ Clay..0- Peat❑ Sandy Loam ❑ Clay Loam-a. <br /> Hardpan ❑ Adobe.❑ Fill Material ............ If yes,type ............................ <br /> iplot 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 available within 200 feet,) <br /> PACKAGE TREATMENT ( I SEPTIC TANK[ ) Size................................................ Liquid Depth .................... <br /> .--•-- <br /> Capacity ...................• Type --------............ Material------------.--------- No. Compartments ......................00? <br /> Distance to nearest: Well ....................................Foundation ....--------_ ----- Prop. Line ...................... <br /> LEACHING LINE [ ) No. of Lines ........................ Length of each line..__.._---.----............. Total Length ............................J <br /> 'D' Box ............ Type Filter Material ................:...Depth Filter Material ..........'_____........_. ................. <br /> Distance to nearest: Well ........................ Foundation ................,------- Property Line .......--.-_..__.------...�! <br /> SEEPAGE PIT [ ) Depth Diameter,. ................ Number ------------- /........ Rock Filled Yes ❑ No t❑g <br /> Water Table Depth ...........Rock Size j <br /> f <br /> Distance to nearest: Well ..........................Foutridation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------•-•---••----- •- Date .... ............................. <br /> Septic Tank (Specify Requirements) ...........................I-------._............ .---- -----------••------••---.....----............... .................. <br /> '570 <br /> Disposal Field (Specify Requirements) ..__- -. %� -r_,1 _a........./ -----sl �Lrt --..._.. <br /> -----------------------------------:k ------- ------------­ <br /> ------ ----- ..----•----•---- •-----........-•••-•--. <br /> .- <br /> ................_----------------________---------------------------------_______----------------w.......________....__s_,._____........_-._.__...._....._______......_____._.._..._____..... <br /> (Draw existing and•required addition on reversg )de) <br /> I hereby certify that I have prepared this application and that the work wiiEba,done in accordance with Son 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 to Workman's Compensation laws of California.;' <br /> Signed ......... ..... ----------------- Owner <br /> C rte.>9k .:.-- •................ .Title ..t� Al/'4 L_ ye............-------- <br /> (If other than owner) <br /> /v FOR DEPARTMENT USE ONLY, <br /> APPLICATION ACCEPTED BY .... ---- - DATE ... <br /> ....... ...... ................ <br /> BUILDING PERMIT 155UI±D DATE ......................... ................ <br /> .. .. ......... .. <br /> ADDITIONAL COMMENTS ........................ ................................................................................................... ................-----............ <br /> . <br /> _.... ... i rl �- .....................:... -•-------------------- ---.....---------------•--•-•------- ----- ' - T- . ; ....._........ <br /> .. l� <br /> Final inspection by: ...... ``' .......................................Date ...._ ..•- .. <br /> ----• ••----.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 13 24 : •; 7/72 3 ME.H. 1-'68 Rev. 5M / I <br />