Laserfiche WebLink
r, <br /> FOROFFICE USE: <br /> = . <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit Na. <br /> ------------------------------------------------- <br /> (Complete in Triplicate) <br /> ----------------- ---------------------------- p. <br /> Date Issued --.----"�_-_.�-.Z <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 .-----l t��--���-----1 ------.i��-��Q-L�,�--------------------- - -----CENSUS TRACT -------�--�-C�-------=- <br /> Owner's Name ------ _L_(�-- '------ IvV N--------------- ---------------- -------------------Phone ------------------------------••---- <br /> k. Address 7�S - <br /> / - __ - -IV -------j D`------- ------ City �SG�} D ---------------- -- <br /> Contractor's Name -- i!1/1 � ---------------------------- -------------------------.License # ------------------------- Phone ------------------------------ <br /> Installation will serve: ._Residencepartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑ Other - ------------------------------------------ <br /> Number <br /> ----------------------------------- ---- <br /> Number of living units:----l-.---- Number of bedrooms -___Garbage Grinder NO.-.- Lot Size C 1��- ��" ........ <br /> Water Supply: Public System and name --------------------------------•------------------------------------------------------------------------------Private [�— <br /> Character of soil to a depth of 3 feet: Sand'❑ It❑ Clay ❑ Peat Sandy Loam •Olay Loam ❑ <br /> Hardpan Adobe F-1Fill Material - - -- 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 available within 200 feet,) d <br /> PACKAGE TREATMENT 1 Li ued De , ----. -------•---.----- O� <br /> SEPTIC T <br /> ANK;[ Size----!---_ -- ----- q P <br /> �. ----------------------------- -- <br /> - Type --=---------------- Material-------- ------------- N3. Compartments ---------------------- <br /> -s �./Distance to : Well -------------------=----------------Foundation -------- -- - Prop. Line ---------- -_-- <br /> LEACHING LINE [ ] �No. of Lines -- - -I- ---_ Length of each line------_---------------- Total Length --_-------_---.---_---_-_-_- <br /> bBox - "---- e Filter Materriial'--------------------Depth Filter Maerial -----.-------------------------•-- -•------- <br /> Distance to nelh---.-- ------ Foundation --------------- --- Property Line. -_--_--_-_---_--_------- <br /> SEEPAGE PIT [ ] Depth ? ' - - Rock Filled Yes No---- - Rameter,f,---�----------- Number -------- ----------- " - - ❑ ❑ <br /> Water Table Depth --- -------------------------------- '-------.Rock Size ---------- ------------- <br /> Distance to nearest: W I — ---------------_-------___----------Foundation ------- ------------ Prop. Line -----_---__---_--__. <br /> REPAIR/ADDITION(Prev. Sanitation.Permit# -- --------------------------------------- Date ------------•--_--_. -------1 <br /> � h <br /> Septic Tank (Specify Requirements). ------- ---- ---------------- <br /> ----------------------------------'t'---- --------j----------- --------,------------------I--- <br /> Disposal Field iSpecify Requirements) .h�T----/—/lV� --------1 ---------44~} ------------- -' <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 /> County Ordinances, State Laws, and Rules and Regulations of the San'Joaquin Lokal Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify n e rform of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to boom ject o Wo n's Compensation laws of California." <br /> Signed ----- ------ Owner ,T <br /> ` Title _ <br /> --------------- --- - <br /> (If other than owner) �` � .p r <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------- --- - t._ ----- <br /> BUILDING <br /> - p <br /> ATE <br /> BUILDING_.P.ERMIT-ISSUED,.:,-------------------- • •-,..--..--._�.:.-----------------------------_.�_- _--------------------- - ATE,_- -:: ------ ---- <br /> ADDITIONAL COMMENTS _. = <br /> - — <br /> F --------------------------------------------------- <br /> = t <br /> --------- -M = ----------- ----------- - - <br /> ,- <br /> 7.Final Inspec }-% _ _ -- _ -- ----- s- T_±DateV _ ` <br /> SAN JOAQUIN LOCAL HEALTH. DISTRICT <br /> E. H. 9 1-'68 Rev..5M <br />