Laserfiche WebLink
FOR OFFICE USE: APPLICATION AOR SANITATION PERMIT <br /> .............. .......................................... Permit No. .. ....�rf� <br /> (Complete in Triplicate) <br /> S-iJ� 7� <br /> ----------.- This Permit Expires li Year From Date Issued 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 ...fed 1�Fr✓. _',._' T�.�� _ ._.. ...L "�-...._......CENSUS TRACT allft,4i..... <br /> Owner's Name ... --i_...... .�S.1L _ .. ...--•-•--•-------------------------••'Cit...-•. �..... _. Phone . .-.��..'.8:�._.�_�.. <br /> " A� .......................................... <br /> Address _...i .o�_ _ _../-�l .H(-... ...........-••-••-•................... y '` / ... <br /> 33 <br /> Contractor's Name ..E�' ..... ... _.�t�.l�---c.�________________________License # . .------ Phone .... <br /> �'rC'` <br /> Installation will serve. Residence ❑Apartment House❑� " <br /> Comm ercial❑Trailer Court C <br /> Motel ❑Other _.A� �- ....... <br /> . / <br /> Number of living units------------- Number of bedroorns3.........Garbage Grinder ------------ Lot Size Z-40.42.44a'......I.._....... <br /> Water Supply: Public System and name ----•----•--•---- -------•--------------------------------------------•------•............................_...Private <br /> Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam �' <br /> y <br /> Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ............................ <br /> {Piot 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 seep a pit permitted if public sewer is available within 200 feet,j �- <br /> PACKAGE TREATMENT { } SEPTICTANIC,V Size. __________ Liquid Depth _..[ --y��._....._ <br /> 4 <br /> Capacity ��D�G_!•Q_ Type._. .__ ...:_•._ ... Material.. No. Compartments .�................. <br /> Distance to nearest: Well ....j-5 ---•...............Foundation ...................... Prop. line . ?....... <br /> LEACHING LINE No. of Lines .....A-------------- Length of each line------ ----------- Total Length" <br /> ll at <br /> D' Bax ..1. _.... Type Filter Material Depth Filter Material ...3.1................................. <br /> �. .. <br /> Distance to nearest: Well :.T. ---------- Foundation Property Line !z <br /> SEEPAGE PIT [4.}— Depth o�.�............. Diameter • .......... Number---------- ............ Rock Filled Yes jzy No <br /> y Water Table Depth .- _t ........-......................Rock Size <br /> Distance to nearest: Well ......t Cp....................Foundation .................... Prop. Line 7��d-zw__--_•.-_ <br /> REPAIR/ADDITION(Prev. Sanitation"Permit# ............................................ Date .................................. <br /> SepticTank (Specify Requirements) .............................___----------------------------------------------•......................................_._---•--------... <br /> Disposal Field (Specify Requirements) ---------- ----------•-------..._............... -----------------------------------------------------------•-------------•------- <br /> _...-------•--.---------•--•------•---------------------v..------•----•----••-•---•----•-••---•--._...-----...-----. --------•----------•--------------- -••---•---•---•- ••---•• -•--..._.._ <br /> .......................................................................-__-________________-_________.......»...____._____-_-_-_-_-_---•--._-•-.---------•-.---_-.-----•--.-•--•-_-_--__._.-.___.-....t_. <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 Distriel. 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 mann <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ................ .. ......... Owner, <br /> . .... ....... ........................ _ <br /> By .._.... ............................•- Title ---�l�kh.1- a <br /> �_.----• <br /> f other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED.. 8Y .... ........................................_...___................_....... DATE',r0, . ...................... <br /> BUILDING PERMIT ISSUED ...................... 0—f...•---............................. .-..... .DATE ----------..................I............. <br /> ADDITIONALCOMMENTS -------------------------------------------------------------•-•-----•-- .................................-.......................:........................... <br /> ..._..-•---•--••--•----•--- -- -=-----------•------- --------------------------------------•-•-................................... <br /> ............................_........--.._.......--•-•- <br /> FinolInspection by: ..... .................................... ------------- -----•--------- .................Date9�..................... ------------- <br /> SAN JOAQUIN LOCALHEALTHDISTRICT A <br /> E. H.13 24 1-'68 Rev, 5M 7172 3 114 <br />