Laserfiche WebLink
' ,EOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ---�'�----=-- ---------------------------------------=�- Permit No. 7�----------' .5 • <br /> i (Complete in Triplicate) <br /> (� Date Issued <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. 349 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _ - - - _ ,_ = —CENSUS TRACT _-01______________ <br /> /70 R__ * M1 <br /> Owner's Name __ # 7 7 �A_A - <br /> - -�------,�:.-u::i:,=:-_---�__� ----- �- ----�- -- - - ------ ------Phone -- --------- <br /> Address---------�--------�}L iA ti=yQ-� , �• i 4= City ^� � <br /> Contractor's Name ---4L-----'Vf� _ _!_EX --------------License # ---------:---------- Phone __---------------------------- <br /> Installation will serve: �� ' #Residence ❑ Apartment House❑ Commercial ❑Trailer Court i❑ <br /> Motel Other __ 112 lL �% <br /> ❑ - == r <br /> Number of living units:------------ Number of bedroorns _ ____-____Garbage GrinderLot Size _�____/. E7_ __________-- <br /> Water Supply: Public System and name __________ 1 ---____ 1v_► T .______________________'___Private <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ ' Peat ❑ )Sandy Loam -❑ Clay Loam E] <br /> - 1 <br /> Hardpan ❑ Adobe ❑ Fill Material __ .____._,If yes,type,64t __i4_LXk <br /> (Plot plan, showing size of ilot, 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 iisrravdilable within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK ] r _ Size_f1 __1:_!�[_ __ Liquid Depth ___________________ <br /> --- <br /> �- I <br /> Capacity -------------------- Type -------------------- Material-_--------- -- No. Compartments ------------- <br /> r: <br /> Distance to nearest: Wel! ------------------------------------Foundation"---------------------- Prop. Line ----------------------- <br /> LEACHING <br /> ____- _-:_._____LEACHING LINE No. .of Lines --______-__ Length of each line__________- '__ __-_ Total Length ____________________________ <br /> 'D' Box ---- ------- Type Filter Material ____________i______-Depth Filter Material ____________________________________________ <br /> Distance to nearest: Well ________________________ Foundation ----------I------------- Property Line _-__-______-.­_____=_ u <br /> u - <br /> SEEPAGE •P,IT� [ ] Depth --------------------;Diameter ---------------- Number ---------------A----------- Rock Filled Yes ❑ No .❑ <br /> Water Table Depth ------------------------------------------------Rock Size ------- ------------------------ <br /> f` Distance to nearest: Well ----------------------------------------Foundation a------ ___- Prop. Line _-._-__--__________-:_ <br /> REPAE ADDITION rev. Sanitation Permit# ------Y 41-,e—__________________-___ Date --- __________ A-711 <br /> `'Septic an (Specify Requirements) '_ __- . <br /> ri ---------------------------F- ----- -- --------------- <br /> Dispo I field Specify Requireme is -______ P-Q.:__ / <br /> I <br /> ---- --------------- --------i�--------------- --------------- -------------------------- --- ------------------------ ------------------------- <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 Sate Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Sa`n 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, 1 shall not employ any person in such manner <br /> as to becomes -e t t Workman's.Compensation laws of California." <br /> i 11 <br /> j. <br /> Signed -- -- --------- -------------------------------------------------------------- Owner <br /> BY ---- ---- <br /> r ----•------------------------ Title _-------------------- <br /> .:[ f other than owner} <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -_ ® ---------------------------- <br /> BUILDING <br /> 1� <br /> -- -- - ------- -------------------------- DATE _ _ ------ <br /> .-_________________ <br /> BUILDING PERMIT ISSUED _ ------- ------•----- --------------D__A--T� E�hh <br /> ADDITIONAL COMMENTS _ —--- c�- - _ -_-- - _-„air- ------ `T------- <br /> (, �. ✓I'' <br /> --- <br /> -------------- <br /> ----------------------------------------------------------------------------- ---- --- ------- <br /> ---------------------------------------------- - ------- --- ------ --------------�-------------------- ------ E <br /> Final Inspection by: -- -- ---------.Date ----- - -------- ------ <br /> 1i SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M ,I <br />