Laserfiche WebLink
FOR OFFICE USE: <br /> -ll____--rf.`_Oz1 'tc_.•_ APPLICATIONnPFOR S� pANITA tel ION PERMITPermit No. ---- _-sl_7 <br /> lete <br /> lic <br /> ---------- -- --------- p fl <br /> Da <br /> ---j ' � te Issued <br /> This Permit Expires 1 Year From 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 C ty Ordi ante No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .. CENSUS TRACT -------------------------- <br /> Owner's Name -------------- f f ----- Phone ! � d <br /> Address . 1E ° - �`� itY - ------------------------------------------------- <br /> Contractor's <br /> - ---------------------------------------- -- <br /> Contractor's Name -------- �_ �f- 'LD♦ - " = .License # ------------------------ Phone 6.~� Q <br /> Installation will serve: '�� ^.. 'Residence )Apartment House❑fCorrlmercial ❑Trailer Court ❑ ' <br /> Motel ❑Other - '---------- --------=------------------' 10 , <br />*, Number of living units:.--.- Number of bedrooms _`......Garbage Grinder __(-V_-C�__ Lot Size ..- � - - ---------------- <br /> f s <br /> Water Supply: Public System_ and.name ----------=---------------------------------- ----•----------------- ------Private ❑ <br /> Character of soil to a depth of 3 feet: t Sand'❑ ' Silt❑ Clay E] Peat ElSandy Loam ❑ Clay Loam P11 <br /> 04 ❑ Fill Material -------------------------Hardpan l] Adobe ... If yes,type ............... <br /> (Plot plan, showing size of lot, location-of system .in -•elation--to wells,-build.ings,_.etc. must be placed on reverse side.) <br /> i NEW INSTALLATION: (No septic tank or�seepagepit permitted'if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] 11 Size--- ------ --------------- ------ Liquid Depth --_----------------------- <br /> 1 Capacity --------------------- Type ---------- `-------Material------------------- No. Compartments ---------------- <br /> Distance to nearest: Well ------------- ----------------------Foundation ------ Prop. Line -----------..-..------ <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ____.._.-------._...--._... <br /> ---- Type Filter Material --------------------Dept - <br /> Depth Filter Material ..------------- --------------------------- <br /> ------ . <br /> Distance'Ito nearest: Well ------------------------ Foundation ----------._______.__ Property Line ---- ------------------- <br /> Depth .-._._ ___- <br /> SEEPAGE PIT [ , ------ Diameter --------------- Number ------___--_.---- Rock Filled Yes 'E] No 0 <br /> WaterTable Depth ---------------------------------------=--------Rock Size -------------------- ----------- <br /> Distance to nearest: Well -----------------------------------------Foundation -------------------- Prop. Line --_------------.__--- <br /> REPAIRfADDITION(Prev. Sanitation Permit# --------- Date --- ----------) <br /> _,--- ..� r ,._._ _._._. <br /> Septic Tank (Specify Requirements)I---------W a <br /> r —I� <br /> DisposalField (Specify Requirements) --------------------------------------------------------------- --------------------------------------------------------------------- <br /> -------------------------------------------------- ----------------------------------------------------------------------------------------------------- <br /> I <br /> -- - ------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ ------- <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 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 /> I as to become subject to Workman's Compensation laws of California." <br /> Signed ----- ---------------------- ------- - - �.-- -- Owner <br /> 4 ' <br /> By -- <br /> Title . <br /> (If of r t an owner) <br /> 19?R DEP ENT USE ONLY $ <br /> APPLICATION ACCEPTED BY ---- --- - ---------------- -----------. DATE - ------ -- ------------- <br /> BUILDINGPERMIT ISSUED ---- ------- -----=-------------------------------------------------------------------------DATE ------------- ------------------------ <br /> ADDITIONAL COMMENTS !__ ------ <br /> --- ----- --------------- ---- ------- - --- ---- <br /> ro <br /> ------------------------------------------------------- <br /> -------------------------------------------------------------------------- -- <br /> = ---------------------------------------- --------------------- -- - <br /> -------------------------- - -_---_-- -------------------------------------------- -------------------- ------Date <br /> Final Inspection by. �� --- - ------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />