Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ---- ---------------------- Permit No. <br /> (Complete in Triplicate) <br /> _________________________________________________________ This Permit Expires 1 Year From Date Issued <br /> 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 andexistingRules and Regulations: <br /> JOB ADDRESS/LOCATION� ____A_g2__-,aan6e-_f-_ ����---- " CENSUS TRACT ---------- <br /> Owner's Name ------�_o te T <br /> Address '$ ------ g_ szx <br /> j` City __.-__. Phone X11a �_c_,License #Contractor's Name ___-- t_" 1_ ; <br /> ._ <br /> Installation will serve: /Residence VApartment House-E] Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other -------------------------------------------- i <br /> Number of living units:__------ Number of bedrooms ----/......Garbage Grinder null--- Lot Size ��r_.x_��n.............. <br /> Water Supply: Public System and name ---------------------------- _ . flldl!_ ------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe'Y Fill 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 /> ize ` -'PACKAGE TREATMENT SEPTIC TANK; Q Liquid Depth <br /> hk . Nc' d aNa Com artments _2________f__ <br /> ____Capacity _-- Type P4�CZJ--- - Materi I-C/ ________ Prop. ...................... <br /> Distance to nearest: Well ._ .. ._...Foundation (,J <br /> LEACHING LINE No. of Lines pQ f p ` <br /> -----�---------------- Length of each e------[i------------ ----- Total Length ----t�------------------- <br /> / �s <br /> D' Box __--------- Type Filter Material ......... <br /> Depth Filter Material ---l-1.........................___.._.._._ <br /> Distance to nearest: Well ------- Fpun ation _---_I-�-_______ Property Line ._-__:_-_Q _`.___ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No 0 <br /> WaterTable Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ____________________--_-_----___,_--Foundation -------------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ___-_______-__-_-_- __----______) <br /> SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------------------•---,..--------------------------- <br /> Disposal Field (Specify Requirements) _---_-_--___ -------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------- <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 in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to b&A6VQ"it pL1 M*lM'18"W?ation laws of California." <br /> Signed --------- P.-O.-Box-254------------------------- /.1-1 <br /> 160 East Grantline Road 1 <br /> itle � <br /> BY - �_ ,0 <br /> F R DEPARTMENT USE ANLY <br /> APPLICATION ACCEPTED BY - ------------------------- - DATE --- ------------------- <br /> BUILDING PERMIT ISSUED ------------------------------ --- --------DATE -------------------------------I----------- <br /> ADDITIONALCOMMENTS ------------------------------------------------6 ---------------------------------------------------------- --------------------------- <br /> --------------------- -------------------------------------------------------------------- ----- --- ------ <br /> - <br /> Final Inspection by: ----------------------------- -- -------------------------------------- Date I _, --------- <br /> SAN JOAQUIN LOCAL HEAL ISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />