Laserfiche WebLink
FOR OFFICE USE: <br /> !i APPLICATION FOR SANITATION PERMIT G <br /> Permit No. __6Z1707__.!� [Complete in Triplicate! <br /> - ------------------------------------------ <br /> �i - Q__vk? <br /> -------------------------------- ------ This Permit Expires 1 Year From Date Issued Date Issued <br /> lE <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 wit Cou ty rdinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOC TION .- S 3S ------------------ CENSUS TRACT <br /> , <br /> Owner's Name ----- -- -a_.c�lJ 1 Phone <br /> iAddress 5 .5---- --- -- --- ---------- -------------- City :_�- - -------------------------------------------------------- <br /> Owner's <br /> = <br /> I'Contractor's Name ---- 1_-- __-- ' "- __--.License # _j _ Phone ---------------------•...... <br /> -- <br /> 'Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court <br /> E1 Motel F1 Other ------- ----- <br /> Number of living units:-------rr-___ Number of bedrooms ---__Garbage Grinder ------------ Lot Size _______________ar_f____________________.-_. <br /> Water Supply: Public System and name --------- -----------------------------------------------------------------------------Private El <br /> :Character of soil to a depth of 3 feet: Sand'❑ Silt❑ C-lay ❑ 'Peat❑ Sandy Loam (Clay,Loam [❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type -----------------------i--- <br /> _ r <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> i <br /> E NEW INSTALLATION: (No septic tank or seepage pit permitted if'public sewer is available within 200 feet,) <br /> 'PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size---------------- ------------------------------- Liquid Depth --_.------------..-.,----- {� <br /> !f Capacity -------------------- Type -------;- ---------- Material---------------------- No. Compartments ---------------------- <br /> Distance <br /> ----- ------Distance to nearest: Well ---_---"----- ----i-------------Foundation ---------------------- Prop. Line ---.------------.---.- U <br /> (LEACHING LINE [ j No:-o{ 'Lines ------------------------ Length of each line----------------------------- Length I{ ------- Total Len ------•----•---------------- yw� <br /> { 'D' Box ------------ Type Filter Material ------_i----_-------Depth Filter Material ------------------------------- ------------ <br /> .i Distance to nearest: Well ____.____.�_____________ Foundation ----- -- ""_- Property Line- ________________________ <br /> SEEPAGE PIT [ Depth ____________________ Diameter, '~______________ Number ---------------------------- Rock Filled Yes ❑ No 0 <br /> Water Table Depth ---------------- -------Rock Size -------------------------------- <br /> ------------------- <br /> ----------------------------- - <br /> ----------------- <br /> Distance <br /> to nearest: Well ----------------------------------------Foundation --`----------------- Prop. Line ---------------------- <br /> y f <br /> €REPAIR/ADDITION(Prev. Sanitation Permit# --_---------------------------------------- 'Date,____�-_'__________________________- <br /> -+1 <br /> Septic Tank (Specify Requirements) ----------"-------- ------------------------------- <br /> Disposal Field (Specify Requirements) --------------•------------------------ ----------------------------------------- ------------- --------------- <br /> ----- -------------------------------------------------------- '--------- - / -------- <br /> -- -- - - - - _ --- ------------- <br /> �,� -- -------- <br /> ' -------------------------- ------ <br /> ------------- ------ ----------- t`^ -- - --------------------------------- <br /> ----------- <br /> (Draw <br /> ------,---- <br /> (Dr�ting a�ed ad ition on reverse side) <br /> �l 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. 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 become subject to Workman's Compensation laws of°California." <br /> f I; <br /> Signed -------- Owner <br /> ----- ----- ---------------------------- <br /> y ------ -- - ------ - = Title <br /> --- ----- -- -------------------------------- <br /> B <br /> (if other than owner) ' <br /> E FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------------------------------------------------------------- DATE - �� �'��------------------- <br /> !BUILDING PERMIT ISSUED -------------------------- ------------------------------ ------DATE ------------------ -------------- <br /> ------------------------------=-------- ---------- <br /> ADDITIONAL COMMENTS ________________________ <br /> :f <br /> E---------------------------------------------------------------------------------------------- - - ----------------------------------------------------------- ---------------------- <br /> - ------------ <br /> E <br /> _______________________________________________________________________________________________________________________________________________ <br /> l Final Inspection by -------------------------------Date 1-- ---- f -- ---------- <br /> { ! SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Ei <br /> 'E. H. 9 1-'68 Rev. 5M <br />