Laserfiche WebLink
FOIL OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ................................ Permit No. 7�"�/�a..[O <br /> ....... ;!_ melete In Triplicate) ................. <br /> h <br /> ............................................ .. This Permit Expires f Year From Dot*Issued <br /> Date lssued -/�-f r_T/ <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 complian wi h Count Ordinance N . 549 and existing Rules and Regulations- <br /> JOB ADDRESS/LOCATION ....-���-1...... .. .... ...... :...........- ...-•�-' n�......._..CENSUS TRACT .................... .._._ <br /> Owner's Name ............ ``................• -----•------.. ............................ ?.;I/ <br /> ...........--•--.....,.......-----................--•--•...Phone /-�.• ----- <br /> Address ......................... '..._.....---......_..---..._._.._...... ...............City �1� ? To ................................... ---------------- <br /> Contractor's Name -------•--- �......License # ........................ Phone �►C6�.9�6 - <br /> Installation will serve: Residence j4Apartment House Commercial(3Trailw Court 0 <br /> Motel❑Other............................................. <br /> f <br /> Number of living units.-.-/------- Number of bedrooms .. ... Garbage Grinder _-_-____-._. Lot Size .f.,4C,4�...................... <br /> Water Supply: Public System and name -------- ----- .....-..........................._......._.........................................Private F <br /> Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay 0 Peat❑ Sandy loam 0 Clay Loom W <br /> Hardpan C) Adobe 0 Fill Material ............if yes,type............... ............ <br /> (Plot pian, 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 [ ] SEPTIC TANK f } Size............•------............................. Liquid Depth ........................... <br /> Capacity --------------------• Type --------•----------- Material...................... No. Compartments ..................... <br /> Distance to nearest: Well ....................................Foundation ...................... Prop. Line ................."... <br /> LEACHING LINE [ j No. of Lines ------------------ ---- Length of each line............................. Total Length ----- ...................... <br /> 'D' Box ------------ Type Filter Material .....•_----_------Depth Filter Material ............................................ <br /> Distance to nearest: Well ................. Foundation ................... Property Line ........................ <br /> SEEPAGE PIT { 1 Depth ------ :.,;.-:-_-_-. Diameter ................ Number ............................ Rock Filled Yes L] No 0 <br /> Water Table Depth ------------•••.....................•---.----...Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation __.......•.......... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ___..--.......... ..................•-__---- Date .............._................... <br /> ) <br /> Septic Tank (Specify Requirements) ...... :' .... ---------- ---................................... ............... <br /> r <br /> Dis osal Field Specify Requirements) j O ---------- ................. <br /> :---•.. ............ ...........................-..-......................... <br /> Dra xisting and Iq'uired'addition on reverse side) <br /> 1 hereby certify that I have prepared this application and th at the work will be done in accordance with San Joaqultm <br /> County'Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Healih:District. Homme owner or Ilcen- <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of the work for which this permit is issued, l shall not employ any person in such manner <br /> as to beco esu )e Workman's Ca pensation laws of California." <br /> Signed .... _c_R_%� -- <br /> �_ <br /> BY - .- _(F•-•----•-----------_-. ..__...... Title (E,-.------ ------ ------- ---------------------------- <br /> Ilf oth r than owner) <br /> r FO&4E0AItTpMENT USE ONLY <br /> APPLICATION ACCEPTED BYE-.... -- -------• - - .------....-.. . .DATE I l A:---- ------- <br /> BUILDINGPERMIT ISSUED ......... ----------------• ---------....---........._._........_-._..--------•---•-•--..-------------DATE .......................................... <br /> ADDITIONAL COMMENTS --------- --•.................. - <br /> ---------•--•---•-- • ------------- -----•- --- : ------------•--..----------------- -----. -.....-............•---• •-------••--.........._..... <br /> -- - `•----------------------------------- --------------------------- ---------------------------- <br /> ------­--------------­- <br /> ----- <br /> ---•-•-•--- ---------------------------• ----.... - -•--- <br /> Fina! Inspection by: _.._ .. ---------------------------------------•--...................._.......---Date ...r._ .. <br /> ::•_:: :: <br /> ..Y/----X <br /> EH 13 2a 1-68 v• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> - - CIO <br />