Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ............................................. . Permit No. .../l�.~.s��. <br /> (Complete In Triplicate) <br /> .........--•.................................. yf <br /> ...................................... .. ... _... <br /> _ ___..___. This Permit Expires 1 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. 5:49 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCAT N 5 .- G ..--• - - ._...... ...............................CENSUS TRACY .......................... <br /> Owner's Name - d- -6.................................. ....... hone —.. ...---..-. <br /> P <br /> Address . . ........�.-It.1.. _.... P'L('C � -. City ...................I...... <br /> .... <br /> Contractor's Name ..... -- --- - •---- - ------ ,. --.License # ---•---•................ Phone .............................. <br /> Installation will serve: Residence Apartment Houseo Commercial OTrailer Court ❑ 1 <br /> Motel ❑Other--- --•--------------------- ............... <br /> Number of living units------ Number of bedrooms ..... ___Garbage Grinder ............ Lot Size ..... .. ............ ...... ........ .... <br /> Water Supply: Public System and name ....... ................................................_........._......--------............ ..............Private . <br /> Character of soil to a depth of 3 feet: Sand D Sift❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ <br /> Hardpan❑ Adobe❑ 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 se pit permitted if, public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK eep gSize_Y!o'--.IZ.. Liquid Depth V.../, <br /> ............. <br /> Capacity •-- Type ................... Material No. Compartments ..r ........... <br /> /Distance.to nearest: <br /> ✓ Well -------rrA_�......._ Foun Foundation <br /> .. Prop. Line ._.-. <br /> ... <br /> Total Length � ...LIACHING LINE No. of Lines •------ --------- Length of each line.._•_- __ G <br /> ..... <br /> 'D' Box ./------- Type Filter Material ....... ...Depth Filter Material ...... ....... <br /> Distance to nearest: Well .....-�.Vr - Foundation .......ZD_ -- Property Line / ....... <br /> SEEPAGE PIT { j Depth ----------•......--- Diameter ................ Number -.--__--.__----------,-- Rock Filled Yes ❑ No CD <br /> Water Table Depth ----------- ....................................Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation .................... Prop. tine ....... <br /> .... .............. <br /> R EPAIR/ADDITION(Prev. Sanitation Permit 5# -------------------------------------------- Date _.................................I <br /> SepticTank (Specify Requirements) .........................................................................................._..............._..............._..... -----•---- <br /> DisposalField (Specify Requirements) ................••----------------............................... .................-•................................................. <br /> ..................................... <br /> --•------------------------ -------------------------------- ------------------------------------••----...._........................................ ................................................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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. Hoene owner or licen- <br /> sed agents signature certifies the following: <br /> 1 certify that in the performanc of the work for"which this permit Is Issued, 1 shall not employ any person in such manner <br /> as to become subject to War a 's Compensation laws of California." <br /> Signed ----------------------------- --•------------- - ......................._--- Owner <br /> BY ---------•------------------- - � ................ Jitle . "fe y "`+� - ---------------------------- <br /> (If other thon owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --•---- -------------- / DATE <br /> . <br /> BUILDING PERMIT ISSUED -------•----- .--...._....--_---------- ........................DATE ..................................... <br /> ADDITIONAL COMMENTS G�tOJ�,�ia�`.- '` -'--- ----•--•---------------------------- -•----------•----•---..._.......:.--•------......_.......... <br /> ......................-.............................. -- - ......... - -- - ............................. <br /> ----------- •-------- ----------------•-------- - <br /> FinalInspection by: ..... f ..----•- ..........................-.----------------------------------------------------.Date d; - <br /> EH 13 21 1-68 itev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />