Laserfiche WebLink
Owner's Name <br />Address A 3 <br />JOB ADDRESS/LOCATION S2 4i-547 <br />Contractor's Name <br />...................... • Signed <br />By <br />(If other than owner) <br />Owner <br />Title <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <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 />S <br />City <br />-444 license # Phone <br />Installation will serve: Residence partment House 0 Commercial .0Trailer Court 0 <br />4 Sr i' <br />Motel 0 Other . ..-. ,.., <br />Number of living units: _ ..... !... Number of bedrooms Garbage Grinder Lot Size <br />.; <br />Water Supply; Public.Systern and name -- Private <br />i <br />Character of soil to ci depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat 0 Sandy Loam.:0 Clay Loam .E <br />Adobe 0 Fill Material If yes, type • <br />, . <br />(Plot plan, showing size of lot, location of system in relation to wells, building& etc. must be placed 9n reverse side.) <br />NEW INSTALLATION: (No septic tank or seepage pit permitted if Public sewer is available within 200 get) <br />--, <br />PACKAGE TREATMENT ( 1 SEPTIC TANK I 1 ; Size . ,-- <br />Capacity Type - Material .No. Compartments <br />--, . <br />Distance to nearest: 'Well Foundation Prop. Line <br />i <br />, . , <br />LEACHING LINE [ 1 No. of ,Lines ` Length of each line Total Length <br />,,,,,..... -TY Box - Type Filter Material Depth Filter Material <br />J 4 <br />- Distance_ to rieaTest: Well Foundation Property Line. - - <br />, # <br />...• • • <br />SEEPAGE PIT [ 1 , Depth Diameter Number Rock Filled Yes 0 No 10 <br />- Water Table iDepth <br />, <br />- :-/ Rock Size <br />Distance to nearest: Well Foundation Prop. Line <br />REPAIR/ADDITION (Prey. Sanitation • Permit # -- Date ) <br />Septic Tank (Specify Requirements) <br />Disposal Field (Specify Requirements) . _ 4 _..—e..1-4.1. ...4-,a7 2e— <br />tp—" <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 District. Home owner or licen- <br />sed agents signature certifies the following: <br />"i certify that i e performance of the work for which this permit is issued, I shall not employ any person in such manner <br />as to become u t to Workman's Cojnpeasalion laws of California." <br />FOR OFFICE USE: <br />Permit No. 7a-7/ <br />Date Issued -•""' 27 -26 <br /> CENSUS TRACT <br /> Phone <br />/ Hardpan <br />, Liquid Depth <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BYe/..-1 DATE <br />BUILDING PERMIT ISSUED DATE <br />ADDITIONAL COMMENTS <br /> <br /> Datea2 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> <br />Final Inspection by: <br /> <br />E. H. 9 1-'68 Rev. 5M