Laserfiche WebLink
FOR OFFICE USE: <br /> ......... ... ..............: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete In Triplicate) <br /> Permit No. ._7S .. <br /> ...... ....................•---............ . . This Permit Expires 3 Year From Date Issued Date issued <br /> ya°:. . <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 isa in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION .- .....................CENSUS TRACT ........................._ <br /> -_-- ..... .... Q� <br /> Owner's Name . �.-1/•• PFJ_._, ....... .....................Phone . f: J� .. <br /> Address . 1. [.....City - ......................... ................. <br /> Contractor's Name ...G_ xi..'f . PTi�.f License # ........................ Phone - <br /> Installation will serve: Residence©Apartment House❑ Commercial❑Traller Court ❑ <br /> Motel ❑Other--•-•.... ........ . ................. <br /> Number of living units._••_' Number of bedrooms .. ._.._Garbage Grinder ......_ .... Lot Size ...... .............. <br /> Water Supply: Public System and name y Private;[ <br /> Character of sail to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ` <br /> Hardpan❑ AdobeFill Material ............ If yes,type............... ............ <br /> (Plot plan, 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 /> ,-.--- <br /> Capacity -----------•----•--- Type .... ---•---_----- Material--- _-----------_. No. Compartments ....................... <br /> Distance. to nearest: Well ........................Foundation .....-__..______...... Profs. Line ...................... MI <br /> LEACHING LINE [ ] No. df Lines .................... Length of each line............................. Total Length .__.._..... ................ N <br /> `D' Box ............ Type Filter Material ____________________Depth Filter Material ............................................ <br /> Distance to nearest: Well ........................ Foundation .._... ...... Property Line ........................ <br /> SEEPAGE PIT I ) Depth -------------------- Diameter ................ Number ---......................... Rock Filled Yes ❑ No Of <br /> Water Table Depth ................................................Rock Size ................... <br /> Distance to nearest: Well ........................................Foundation --_--------------. Prop. Line ..__............. <br /> :..._ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date .................................. <br /> Septic Tank )Specify Requirements) <br /> - ----••. -.... ............................_... - <br /> Disposal Field (S ecify Requirements) ---•-- A--- - '�..._._.... .....•. --- <br /> !f t ", <br /> .-. ..__ ................... <br /> .. F ' .tN .2.+�r/51..-- Lam/ • f,. . . . <br /> -------------------------•--,_....... --------------- ----------------•---.-_....-- ---•-•--•--•... -- -. • ......_......._..-----••--••--- ------------......_.........� <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 Health:District. Home owner or Iicen- <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 bec nme subject o Workman's Co ensatie ws of California." <br /> --- ►... i <br /> Signed _._. � �_.3i'`-_�5+_�'....�-�-.............................•--•---L9wrtier, , <br /> BY -----------•••---•- - . ._.. _ ...••--- Title --- �_..,.... <br /> (if other than owner) <br /> _ IF& DEPART NT USE ONLY <br /> APPLICATION ACCEPTED gy ....... .......••....................... DATE .9!7/.U. _75 .._..... <br /> BUILDING PERMIT ISSUED - ..•--•-- ------ ------------------------------------------DATE ..-- •-- <br /> ADDITIONAL COMMENTS ---- •- • ••- •------------------------•------...... ........ <br /> -------------••- - ---------------------------------- ------ -------------..._._-- -------------------. ------------•......... ------- --•---- ----•--...----•-------...._...........-•---....-•--- <br /> ----------------------------------------- <br /> Final Inspection b . Date $$ � <br /> EN 13 2h 1-68 Rev. 5M SAN JOA IN LOCAL HEALTH DISTRICT 8/71; 3M <br />