Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT � T 07 <br /> ---_...._ ..... ....... <br /> #Complete in Triplicate? Permit No. ........ <br /> .....................--------..................I........ This Permit Expires 1 Year From bate 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 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .... 3a.. _ ....,�!.d? ..-rN!57F!� .-- <br /> ,�/ .......................CENSUS TRACT .......................... <br /> Owner's Name ............IyAlY /y��lJr z- Phone <br /> ....--••.......................•----------.•,._...-•---------...... .................................... <br /> Address ............................ .. ...................... City rc?........_.__._................................. <br /> .... <br /> � tsr� -�sJ� ...........License # 5 - <br /> Contractor's Name ...................:..- -�41°�k.___•------ ....-_... ... <br /> Installation will serve: Residence (Apartment House] Commercial ❑Trailer Court ❑ <br /> Motel ❑Other ............ ............................... <br /> Number of living units............. Number of bedrooms A......Garbage Grinder...........___..,i.ot.Size .... P-es <br /> Water Supply: Public System and name --------------•----••-•-•----••-•-• ------------ .............I........ ................Privateer <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay 4 Peat 0 Sandy Loam ❑ Clay Loom ❑ <br /> I <br /> • :' <br /> Hardpan(�( Adobe - Fill Material ......._.+ If yes ty�e ............................ <br /> (Plot plan, showing size of lot, location ofsystem in relation to- weir, 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,J V <br /> . — I <br /> PACKAGE TREATMENT J SEPTIC TANK'I j Size.................... .___.._........... ........ Liquid Depth .......................... <br /> Capacity ------------------- Type ...._��....... •-- Material.'.............�...... No. Compartments ...................... <br /> Distance to nearest: Well ......... ..::.j.................Foundation ............� <br /> . ......... Prop. Line ...................... <br /> No. of Lines __..___._ .............. t <br /> LEACHING LINE <br /> [ ) •.--••.-•-•.. Length of each line-------------=-------•___---Total Length ............................ <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material .......... <br /> Distance to nearest: Well ................... .... Foundation ......... Property Line ..:........ <br /> SEEPAGE PIT Depth __ Diameter Number _ .y_..--------- Rock Filled Yes El Na <br /> • Water Table Depth ............................ Rock Size _._. s-.'_.. <br /> .................. <br /> Distance to nearest: Well ------------------------------------....Foundation=---.................. Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...................... ..................... Date ...................... ) <br /> Septic Tank (Specify Requirements) -----------------------._...... •...... <br /> . ....... ....`... ._.,......... ....-- ........---..............................--------................. <br /> Disposal Field (Specify Requirements) ....._.. k)`'%k- ............... ................................................... <br /> -----------------------....------___.._....--•----------------- --------------- ----- .......................... .............•------------------------ <br /> ----------------- ---------------------------••---._._............----•-•-••-...------•----•--•---••-••---...----...----------••--•••-•---•---•-•--•-=-=--==------------------------•--------- <br /> (Draw existing and required addition on reverse side) <br /> 1 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 ovWer 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,'lsu annex` <br /> as to become subject to Wo man's <br /> Compensation laws of California." <br /> Signed ......... •-• . ._...._................ =----- Ow <br /> ner <br /> BY ••---------- ---•........................•------ Title <br /> ` <br /> ................ <br /> fother than owner) - -c <br /> FOR <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .W ..... • aZ.� ..J1....... -------. DATE .._�1 __.•2.0 ....�..J.........•... <br /> BUILDING PERMIT ISSUED ---------------------------------------------• . ...:......-----...DATE ........................... --------------- <br /> ADDITIONALCOMMENTS ................•--......_....-----•-----------------------------•--------•---. -•-----------------• -----------------............:.--•----------------------- <br /> --------------------------------------------- Y ._.._.::_:_... <br /> . . ... ... . . . . <br /> ................ <br /> - Final inspection by. --- -- g �............................... <br /> . ........ ....... ..Date . �.. r........................ <br /> SAN JOAQUIN LOCAL' HEALTH DISTRICT <br />�1 E, H.13 241.'68 Rev. 5M 7/72311 <br />