Laserfiche WebLink
FOR OFFICE USE: .1" <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. ............... <br /> (Complete In.Trlpllcatel <br /> This Permit Expires t Your from Date Issued Date Issued ..5............... <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/LOC TION ..... s�...4lc.�) .c.�`�'.OQI-Zle. ....�a.?� ..........................CENSUS TRACT .......................... <br /> Owner's Name .... . A `C7?Q f7_�I... (. °�� _ .. ...... ......................Phone •-•-- <br /> Address --------------,O.19-al ... ._ ... .... City . 7� TE'.! .......--- /-•.--.---_- -- <br /> Contractor's NameR. P__-- -- lQ2L ' _.`t<_ - License ......................... Phone <br /> Installation will serve: Residence IRA.partment House Q Commercial QTrailer Court Q <br /> Motel Q Other............... .............. / <br /> Number of living units------I...... Number of bedrooms .."bcin er .... ..... Size s+ ... ......�._._...._Water Supply: Public System and name -----•------•--._•-------- ----- .........:......PrivateCharacter of soil to a depth of 3 feet:' SandQ SiltC'3 t Q Sandy Loom Q Clay Loam <br /> Hardpan ❑ Adobe Q F€llMaterlol ........•...If yes,type ............... ............ <br /> (Plot plan, showing size of lot, locatlon of system in rotation 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 l I SEPTIC TANK Size._._) .._--_ .,--..... Liquid Depth -------------------------- <br /> Capacity _r1, ...-- Type ��-4 `-._. Material..._ No. Compartments ..: ....... <br /> *� +�' <br /> Distance to nearest: Wel! ................Foundation ..... .....--- ....... Prop. Line ..-•-----...... <br /> _...... <br /> LEACHING LINE No. of Lines ...._.. . Length o each li e.._ g �1 <br /> ` --- ... Total..Length ........� Q_.. <br /> IType Filter Material !"Y'(11_'Pr!D&-bpth .Filter Material /..�..D' Box ----- -----. ........... ............. <br /> Distance to nearest: Well ... .o.l _---_-- Foundation .. .----..... Property Line .. ............... u, <br /> SEEPAGE PIT Depth ._- - .. Diameter ZZ._...: Numbers`---..-Z................. Rock Filled Yes 0 NO.IQ <br /> e Depth �_ . `? ............Rock Size ............ <br /> / ... <br /> 3 .. ..--- <br /> Water Table � <br /> Distance to nearest: Well ._-Nlo_±'M.rl .....................Foundation. ......TV.... Prop. Line ....... .._.....__.. <br /> OEPAIR ADDITION Sanitation,Permit# .....................................:.---- Date ....-.•__...___.._•_:__._-- ----- t <br /> / (Prev.( .......................................• -: ......................................_. ..... <br /> . ._._ ....._......:•• i <br /> Septic Tank (Specify Requ�remenis). <br /> ,Disposal Field (Specify Requirements) c° -- - ------ --- ---- - --- - •. - <br /> .-. --�__.._ --- � .-------- <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 Local Health.Dishict. Horne 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 shalt not employ any person In such manner <br /> as to become subj ct to an's Compens aws of California." <br /> Signed . ice 1 ----------------- 49"" r <br /> BY .................. ------------- ---- ................ _ xitle <br /> ( other than own <br /> FOR DEPART ENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------- ...... DATE.�J�_-�=-- <br /> . ------- •--- <br /> BUILDING PERMIT ISSUED -.-- - -- -•• - ,... DATE <br /> ADDITIONAL. COMMENTS .. 4�-.:_. _ !-tc1 ,4.�r�,aP-. ,�.a <br /> ------------ ------------ ------- ----------- ------- -•------•- ­---- .... . ...................... . .-- ------------------- .---•- --•-.-.----------------- -_ <br /> -------------------- ----- ------------- ------ <br /> ----------- Date ..-----•-•-•----------.---- <br /> -- ---------•------------ <br /> -----------------------•-•------- -------- --------- -- -------- - - •------ ----------- ---- -------------------- - <br /> Final Inspection by: --- �� -- � ... . -•_--- <br /> : ... <br /> EH 13 2L 1-68 itev• SAN JOAGUIN LOCAL HEALTH DISTRICT 8/74 3H <br />