Laserfiche WebLink
FOR OFFi EW= E-` <br /> -7 4 'APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----------------------------------------------- ---------- (Complete in Triplicate) <br /> -----------I---------------------------------------------- Date Issued This Permit Expires I Year From Date Issued, <br />------------------------- <br /> =--------------I---------------- it <br /> ructiand installithe work herein <br /> Application is hereby made to the San Joaquin Local Health District for a permit to const <br /> No. 549 and existing Rules and Rebulations: <br /> described. This application is made in compliance with County Ordinance <br /> 44a - <br /> JOB ADDRESS/LOCATION -------------- ----- -------CENSUS TRACI -------------- <br /> 7,4 <br /> -------- <br /> .-Phone <br /> --------------------A--I------- <br /> Owner*s Name � 9--- --- --•- -- ----------------------------------------------- <br /> -----------------------------­ City _-1454 ---------------------------------- <br /> Address �0------- --------License # 24__!Y _� 4 <br /> Phone <br /> Contractor's Name ------ <br /> � <br /> Installation will serve- —Residence [Apartment House❑ Commercial E]Trailer Court C] <br /> Motel M other --------------------------------------- <br /> 2 �G ''`' ^ -------------------- <br /> Number of living units:---! --- Numberj <br /> of bedrooms .__,t"// <br /> __---_Garbage Grinder ------------ Lot Size ---5.- - <br /> ---:-Private El <br /> Water Supply: Public System and name .---` ---------------•-------------------------------------- -------------------- <br /> Clay Loam.0'. <br /> Clay E] [!]I Sandy Loam -El <br /> Character-of soil to a depth of 3 feet: Sand 'Silt 0 1 <br /> _ <br /> Hardpan Adobe F-1 Fill M' -- <br /> Material ------ --- if yes,t;p�eI------------------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, 1,.etc. must be placed on reverse side.) <br /> I <br /> 'I ffikle within 200 feet,)ie­dL if—u bI w-slewerzi s Lava i ci__� <br /> NEW INSTALLATION: (No septic ton or seepage pit permitte <br /> ------------------- <br /> PACKAGE TREATMENT SEPTIC TANK Size_ _ -xze'-7--------------- Liquid Dept <br /> Capacity ------- Type Mciterial-40&41------- No. 'Compartments -------------•--I___- <br /> Line . <br /> Distance to nearest: Well ------------Foundation ---------------Prop. Li 4E-------------- X <br /> I . I ph -----RAO............. <br /> LEACHING LINE No. of Lines -------------- Length of each line,/d4--------14aO--- Total Length .00 <br /> 'D' Box ------ Type Filter Material Depth Filter Material ------- ---------------- <br /> - n __A-0-------------- Property Line --------- <br /> ISI <br /> Distance to nearest: Well 15_0--------------- Foundation ---- <br /> # Diameter YPk-0-j Number --------- -------------- Rock Filled Yes J�T No <br /> -SEEPAGE PIT Depth ---------- Di --------- I fr <br /> Water Table Depth ------- --- -------------------------Rock Size ------------- <br /> ----=_--Prop, -Lin <br /> Distance to nearest: Well -JO-4)----------------------- Foundation 520 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------- Date ---------------------------------- <br /> I --------------------------11--------------------------- <br /> Septic Tank (Specify..)Requi rements) --------------------------------------------------------------------------- <br /> I -- <br /> -- -- -- <br /> ----- ----------------------- - ----- -- --- <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------ ------------- <br /> ------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------- <br /> ------------------------------- ------- <br /> -------------------- <br /> i (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 Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner orlicen- <br /> sed agents signature certifies the following: ed, I shall not employ any.person in such manner <br /> "I certify that in the performanceIs� issued,the work for which this permit <br /> as to bec a ubject to Wo man's ompens <br /> C cition laws of California." <br /> Owner <br /> Signed -- <br /> ---- <br /> Title - -------------------- - -- <br /> BY ------------------(----- <br /> __if other-- than owner) <br /> FOR DEPARTMENT USE ONLY DATE ------------------- <br /> APPLICATION ACCEPTED BY I- --- - ----- -- ---------------------------------------------------- ----------DATE ------------------------------------------- <br /> BUILDINGPERMIT ISSUED --------- ----------------------- -------------------------------------------------------------- ------------ <br /> ADDITIONAL COMMENTS -- ------ ---------------------- --------------------------------- <br /> ------------ <br /> ' ---- ------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------- ------- --- ------ <br /> ------------------------------- ------------------ -------------------------- <br /> ---------------------------------- ------ ------------------------------------- -----Date --- --- <br /> -­ - --------------- ------------- --------------------------------------------------------------------------- <br /> Final Inspection by. _4---- --------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br />