Laserfiche WebLink
11 <br /> FOR OFFICE USE: 1 <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. ..7� <br /> (Complete in Triplicate) <br /> ,m Data issued ................ <br /> •„ This Permit Expires I Year From Date Issued <br /> ........................................ . ........ i <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 compho c with County rdina a No. 544 and existing Rules and Regulationsi <br /> w <br /> JOB ADDRESS/L N ._ � � ... .2 ................ ............---.......... .. Phone .................................... <br /> Address ... . o.. - :y. 1................... City . ... ....... ..................................................... ... Phone .............................. <br /> installation will serves Residence Apartment House❑ Commercial Froller Court 0 <br /> A n Motel Q Other............................................. <br /> Number of living units!....-� Number'of bedrooms Garbage Grinder ............ Lot SizeW........................................ <br /> Water Supply: Public System and name ..................................._-----•----------- `�`-•--•-...................... ..••--.......•••Prlvateta <br /> Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay ❑ Peat❑ Sandi) Loam 0 •• Clay Loam ❑ <br /> Hardpan Q Adobe Fill Material ............if.06,type............... ............ <br /> !Plot plan, showing size of lot, location of system In relation to wells, buildings; etc- must be placed on reverse sld <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available withn 300 feet,) <br /> PACKAGE TREATMENT U SEPTIC TAMC f ) Size.............................................` . Liquid Depth .......................... <br /> Capacity .................... Tyle .................... Material....:. ... ....`.:... No. Compartments -- ..... ----- •._ <br /> . —� Prop. Line <br /> ' Dis#once to nearest: Well .........Foundation � -••---••••-•--- <br /> =_EACHlNG LINE [ } No: of Lines ........................ Length of each line.............:.:........... Total .Length ......................... <br /> Box --_......... Type Filter Material .......... ......Depth Filter Material ....................... ............ <br /> . Fol nclatl6n ........................ Property Line <br /> Distance to nearest: Well ............. .:. , ••••• ............... <br /> SEEPAGE PIT [ } Depth .................... Diameter Z........... Number ............................ Rock Filled Yes ED No <br /> Water.Table..Depth _. .............................. .._Rock Slee_ .............................. <br /> I Distance to nearest: Well ........................................Foundation .................... Prop. line .................. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. <br /> } <br /> Septic Tank [Specify Requirements! ---....... ...............�............................ <br /> .. .»........�................ <br /> Disoosai Fiei (Specify Requirerpe ts} ��.�Q: ..................... .......... ........ _............ ............ <br /> ... ... <br /> ....................................'............................................................................,........................................... <br /> ---...........__........... <br /> (Draw existing.and requkce addition on reverse side} <br /> I hereby codify that I have prepared this application and that the work will be done In accordance with San Joaqui <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, I shall not employ any person in such manner <br /> as to beco ct t Workma 's Comp motion laws of California." <br /> 1 <br /> :7:gnec' .. _ .... <br /> .... <br /> ....... <br /> ------- <br /> .................... Owner <br /> .. Ad <br /> l ............... �...:.................... <br /> B <br /> Y ..... .._.... .._....... __._ <br /> (if other than ownerl <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> ' APPLICATION ACCEPTED BY .. . ................................... <br /> .DATE <br /> BUILDING PERMIT ISSUED ..DATE-........................... <br /> 4 <br /> ADDITIONAL COMMENTS <br /> F ..... .................................. ............................. ................-....................................................... <br /> ................... ...... ....................... <br /> �- . , . ..... ........ ..... <br /> .. ........... <br /> r Final inspection by <br /> .............. <br /> E" 13 2h 1-68 Rov. SAN JOAQUIN LOCA HEALTH DISTRICT 8/7h 314 <br />