Laserfiche WebLink
Permit No. <br />Date Issued ,2 <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br />,FOR OFFICE USE: <br />Septic Tank (Specify Requirements) <br />Disposal Field (Specify Requirements) <br />33 • f x <br />Signed . <br />By <br />(If other than owner) <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 -N. Y i- er'6- -f,-.-;-git- - - --- --- -----CENSUSTRACT t9 V6 <br />r <br />Owner's Name <br />Address A 9dc, / y .,._ -lee ,City 42.8.0...2 <br />Contractor's NameezA41,,_;,....j.) <br />. License # /_efOrr-rg",' Phone <br />Installation will serve: _ Residence partment House 0 .Commercial 0Trailer Court CI ---, . <br />Motel iii Other <br />Number of living units: I Number of bedrooms cA- Garbage Grinder Lot Size <br />Water Supply: Public System and name • Private <br />Character of of soil too depth of 3 feet: Sand '0 ilt 0 !Clay 0 Peat 0 Sandy Loam .0 Clay Loam 0 <br />• - Hardpan ff Adobe 0 'Fill Material If yes, type 1 <br />, <br />LEACHING LINE No. of Lines Length of each line Total Length <br />1'D•--Box -.Type Filter Material ' I Depth Filter Material 1 <br />Dista nce to nearest: Well Foundation Property Line <br />SEEPAGE PIT [ ] Depth Diameter Number Rock Filled Yes 0 No 1[3\ <br />. , .. <br />_ \ Water Table Depth • Rock Size ..... - . . <br />Distance to nearest: Well Foundation Prop. Line <br />REPAIR/ADDITION (Prey. Sanitation Permit # Date I <br />Phone <br />(Plot plan, showing size of lot, location of system irlirelation to wells, buildings, etc. must be placed on reverse side.) <br />I , • <br />NEW INSTALLATION: 1 <br />1 <br />(No septic tank or seepage pit Permitted if public sewer is available within 200 feet,) I <br /> <br />PACKAGE TREATMENT ,[ ] SEPTIC TANK I ] ° 1 Size Liquid Depth <br />Capacity Type ! Material ..... . . ._ No. Compartments &.) <br />- .. 1:1 Distance to-nearest-Well I i Foundation Prop. Line <br />00 <br />(Draw existing and required addition on reverse side) <br />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 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 become subject to Workman's Compensation laws of California." <br />Owner <br />;title ................ <br />." FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY DATE 4- 0 <br />BUILDING PERMIT ISSUED DATE <br />ADDITIONAL COMMENTS <br /> <br />Final Inspection by: Date - 7 <br /> <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. H. 9 1-68 Rev. 5M,