Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE: <br /> Y. .a..¢� APPLICATION FOR SANITATION PERMIT <br /> -------- /° ------- Permit No- --------------------- <br /> _y * �, [Complete in Triplicate <br /> ------- •-------- -------------------------------- � Date Issued �'-_5-'�d <br /> ------ --------------------- <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 <br /> r -----------------------------CENSUS TRACT -------------------------- <br /> JOB ADDRESS/LOCATON --'--- - -�p-----q----- -- --�- ----- - <br /> Owner's Name �- YV.-� Lr�'f^- ------------- Phone ---------------------•-----•---- <br /> ,'7 <br /> Address ------------- l -------- --- +- ro-k9--------- City <br /> e ]—` license # _. _c �°2- Phone __ -------------------- <br /> Contractor's Name ---�?�'�---••�-Q�------------------------------------------------ / -� - <br /> Installation will serve: Residence*Apartment House-[] Commercial ❑Trailer Court '0 <br /> R Motel ❑Other --------------------------------------------- <br /> C <br /> _ - I <br /> Number of living units:__.:_- ____ Number of bedrooms <br /> ------------ <br /> rrbage Grinder ___.____--- Lot Size - 5----- - '3 ------ <br /> Water Supply: Public System and name -- t <�- F t'--.�----J�-�-�'��1-------- --------------- ------------------Private ❑ i <br /> __ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt El Clay ❑ Peat ElSandy Loam El Clay Loam El <br /> Hardpan ❑ Adobe Fill Material _ fl___ If yes,type _____.__--________________ <br /> - <br /> r <br /> {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> se'epdge pit permitted if public sewer is available within 200 feet,) - - <br /> NEW INSTALLATION: [No septic p c tank or ��-�2 1/� Liquid Depth <br /> /-_�d-_Q_--.----- V <br /> PACKAGE TREATMENT [ ] SEPTIC TANK .-__ .lZ- - ! q p ` <br /> I / § <br /> IMP <br /> Maters OY�L-. No.!Compartments / <br /> Capacity l�d�---- Type P,',__&iz'4-_ aC� �r ) <br /> y Distance to nearest: Well -------—----------------------Foundation ----lz1_ --------- Prop. Line -_ -- C <br /> f I <br /> �__ _ Total Len th i--�R-----------�--. <br /> LEACHING LINE No. `of LirtesY� =----- - ----- Length of each line_ -- $ <br /> f ��- 2©p ilter Material = <br /> D' Box _,� �- Type Filter Material __ IZ " ---- - p <br /> Distance fornearest:,Wei(.__-- f=--•_..Foundation - - - =---------- Property Line. ------------------•=•--- <br /> ' Rock Filled YesX No .j❑ <br /> f ! , 1 Number -- f- 3 <br /> SEEPAGE PIT �( Depth �_'�--------- Diameter <br /> w- --- -------Rock Size :'------ <br /> Water Table Depth �_-1------ -- -'-- -- <br /> - ___Foundation i_._ -- --------- Prop. Line _4;_________________ <br /> Distance to nearest: Well ------------------- <br /> REPA1RfADDITION(Prev. Sanitation Permit# ----------------------- -------------------- Date --------- ---- ) <br /> i ---------------- <br /> Septic Tank (Specify Requirements) --------------------- --------------------------------- r" <br /># ---------------- <br /> - --------------------------------------------------------- <br /> Disposa! Field (Specify Requirements ------------------------------------------ - <br /> I ------------------------ <br /> I ----------- <br /> ----------------------- <br /> i - =-=--- - --------------------------- ------------------------------- <br /> 3 <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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 Healih District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "1 certify that in the performance of the work for which this permit is issued, I shah not employ any person in such manner <br /> r as to become subject.to Workman's Compensation laws of California." <br /> " - m-,..__._� _....-,..� --. __._. . , Owner <br /> fSigned ----------------------------- ------------ - --------------------- ---- �- -----�---- <br /> �""``' Title <br /> (If other than own, r f <br /> k FOR DEPARTMENT USE ONLY, . <br /> r <br /> I APPLICATION ACCEPTED BY _- _ _ DATE ___".Z_.-----+J ' � <br /> BUILDING PERMIT ISSUED ---- 1-------------------------------------------- -•--------------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS --_- <br /> ----- -- -------- <br /> -- --- ��/Z� r <br /> ------------- ----------------------- -- -- ------------------ <br /> ------------------------------------------------ <br /> ------------------------------------- ---------- -------------- - <br /> ---- <br /> - - -- --- -- - <br /> � - - - -- Date <br /> ------------------------- <br /> Final Inspection by: ___ ___. <br /> i SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 4 E. H:_9___� 1-'68 Rev. 5M <br />