Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit,No: 7�X53 S`-- <br /> - ----------- -- ---��--'w. �� � - =7L <br /> --------------" - - - (Complete in Triplicate) ,v� <br /> :---- - <br /> ------ `�.� <br /> Date <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 insfiall the work herein <br /> application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations— <br /> described, This app ' i <br /> JOB ADDRESS/LOCATION <br /> ----CENSUS TRACT --5----`- j <br /> TPhone '^�' <br /> -------------------------- --- -------A <br /> Owner's Name ----- Aom- <br /> % <br /> _ _ -- - �' <br /> city <br /> "" -V! <br /> - � <br /> Address _ � <br /> . � - = <br /> -License # - -- PhoneAA= lfO� ' <br /> Contractor's Name -__.� .- �---------------------------- �-- <br /> Cour <br /> installation will serve: Residence E]Apartment House❑ Commercial ❑Trailer [] <br /> Motel E]Other ___-- 1114 - - - ------ -- ' ` <br /> _ : " --- J <br /> Number of living units:____ _ Garbage Grinder Lot Size ------ ----- -----�_"""- Number of bedrooms ; <br /> .______ , Private L <br /> Public System and name _a n" ----- -- <br /> ----------------------------------- <br /> f°---------I-------------- I <br /> Water Supply: Y 1 CIayAoam-Q+ �•�� <br /> Cla Peat❑ --,Sandy-Loam. <br /> Character of soil t� o� a depth of.3 feet: _Sand' �Sikt,[]_ Y�_C7� <br /> T _ j Adobe ❑ Fill Material ------------ if Yes,type --- --------- <br /> Hardpan❑ � ---" <br /> (plot plan, showing size of lot, location)of system in relation to' wells, <br /> buildings, etc <br /> must be placed on reverse side.) <br /> P seep( e.pit permitted i� ublic se er is av kilable within 200 feet,) ,/ <br /> NEW INSTALLATION: (No septi tank or v {7 <br /> /` _ s P _ Liquid Depth -----_ . <br /> € TREATMENT [ ] SEPTIC TANK [ Size +� - -,/ : ..� . ___ .. W <br /> PACKAGE T P <br /> Ca acit c. j <br /> Y TYP L Wateria compartments f <br /> t � � <br /> QQ Foundation _ -------- Prop. Line . <br /> Distance to nearest: !Well ---l-0-------- <br /> f� Len th of each line_-_ Q----------•----- Total Length 1-414)------- -------- <br /> LEACHING LINE [ 1 No. of Lines -----i----- g <br /> ---- <br /> L- --•----------- <br /> 'D'.Boxy/5- Type Filter Material X. -Depth Filter�Materiai " <br /> �. �",�-- PropertyLine �� <br /> .'�""'��.�'..'.....' ------- Foundation - --- ------- -- - -- ------------ -- <br /> �. Distance-;.to:;nearest.: Well`- <br /> Depth Diameter Number Rock Filled Yes No E n <br /> I SEEPAGE PIT [ I P ------------------� -------•---- <br /> i • Water Table DePT €------------------------------------------------Rock Size -------------- <br /> + Foundation - Prop. Line ----------- <br /> Distance to nearesit lWe --------------------- <br /> ------------------- <br /> E lDate -------•-----------•---•----------) <br /> REPAIR/ADDITION{Prev. Samtatii n Permi 4# -------------------------------------------- <br /> Septic Tank(Specify Requirements) ------[ = <br /> ---------- ------------------------------ <br /> I <br /> f -1 t = -------------------------------- <br /> Disposal Field {Specify Requirements) � -i, ----------------------••----- -------- -------- -------- --------- ------- -------- -------- <br /> 1 -------------------- ----------------------------------------------------- ------ <br /> �- <br /> r , . ---------- <br /> - -- ----- - <br /> rr IDrawjexisting and required addition on reverse side) <br /> ' 1 T{ rtify that I have prepared thi application and that the work will be done in accordance with Sun Joaquin <br /> hereb <br /> County`O finances, State Laws, and Rules �nd Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> e <br /> sed agents signature certifies the following: 1 person <br /> in such manner <br /> "I certify that in the performance of the worjk for which this permit is issued, { shalt not employ any p <br /> as to, come subject to Workman,$ Compensation laws of California." <br /> i Signd._.. '� Owner <br /> -- - --- - ------ <br /> Title1 _ / - I� ' <br /> If ther th n owner <br /> ti I R .DEPARTMENT USE ONLY <br /> € �� =7 <br /> -------------------------------------------- <br /> DATE -------��-- ---- - <br /> APPfL1CATION ACCEPTED BY __`�^�`---A, > ------- - -------- - -----------DATE ------- ---------------- ------- -------- <br /> BUI'LDING PERMIT ISSUED -------- ------ I° --------------- --------------------- ---- <br /> AdDITIONAL COMMENTS ----------- --- --------[----------------- - ----------------------------------------------- ------------------------------------------- <br /> - <br /> - <br /> 1 =1 . <br /> ------------------- ---- <br /> . i --- - -------------------- ---------- <br /> -------- - --- <br /> ---------------------- - ---=--- -- ------- - ----- <br /> t----------------- € ----------- <br /> ----- - e <br /> - - <br /> Finallnspection _ t-." <br /> - --- - -:Dat -- - -- <br /> _-�...� ) <br /> -:�'--2—SAN JOAQU.IN LOCAL HEALTH DISTRICT <br /> -F-H.,_9--—1-'68-Rev-5M-- — <br />