Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT �3 <br /> Permit No. ------ - --- <br /> (Complete in Triplicate) <br /> ---------------------------------------------------------- <br /> Date Issued //'i4�Lc- 73- <br /> is Permit Expires 1 Year From Date Issue <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 mad i �jA llance with County Ordinp�nce No. 549 and existing Rules and Regulations: <br /> t` - <br /> CENSUS TRACT <br /> JOB ADDRESS/LOCATION .- -- � i" r'E--L ``c' _ <br /> 'r'�--- ------Phone <br /> ` o <br /> Owner's Name ------ - ------- - - ---.-------- - ------------ -------------- ---- ------- --------:----- -------=-------- - <br /> 4 CifY 4 1. Gt}�----------------------------- <br /> Address 1 ��---- -- ------� 'V i 'Q,-----1�-'V'V,f'- <br /> Contractor's Name s11-!mac 1- r�-� f _-� __- - ------ • --•[�oY---license # -OV91-10---- Phone _ -- --- ------ <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial :F1TrailerCourt ;�] i <br /> N' Motel ❑ Other ------------------------------------------ <br /> Numberfof living units:_s _ -__ umber of bedrooms ________--__Garbage Grinder - --_____._ Lot Size -- ' -�'�-�--• <br /> Water Supply: Public System and name ------------------ --------- ---------------------------------------- - Private !� E <br /> Character of soil to a depth of 3 feet: Sand'R Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe [7] 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 seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK:j I Size-------------�---------------------------------- Liquid Depth -------------------------- <br /> Capacity .-I -- Type ------r`- ---- Material---------------------- No. Compartments -------------_------- <br /> r - <br /> Distance to nearest: Well ------------------ ----------------Foundation ---------------------- Prop. Line ----•----- ---.,------ <br /> - <br /> LEACHING LINE [ ] ' I -.---_-- Total Len <br /> No. of Lines _______________________ Length of each line_- Length <br /> D' Box ---�--------- Type Filter Material ----- --Depth Filter Material ------------------------------­------------- <br /> yDistance to nearest: Well _____________________ __ Foundation ------------;-------- -- Property Line ------------------•=---- <br /> A f <br /> SIT [Jt] Depth..,--' -.-(�---------- Diameter �Q__a`� Number -----------I----------- -- Rock Filled Yes No ❑ S. <br /> i O- -------- - Rock Size --------------------- <br /> 777e C _d Water Table Depth ------------------ -- <br /> Distance to nearest: Well ___/1 CC:I--------------------- ----Foundation :_-_ d ----- Prop. Line ____-�.�-.__-----.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------ .----------------------- Date -----------------•------ ) <br /> Septic Tank (Specify Requirements) --•------------------------------------------------------------------------------------------ ------- <br /> Disposal Field (Specify Requirements) 0)---I# D ' �' p-"�'- ---`------1 ` I- -�--! aP� --------------------------------- <br /> -:--�---=.------ <br /> f <br /> .. ----------------------------- ------ ______________ ___________________________________+_______________________. <br /> -111___________________._____________�' ___________--_______-_-________________________________________ - <br /> ___. <br /> _____________------------------ -.__ _ _ _ �you <br /> r (Draw existing-and"'equire 1c ad'dition on reverse side) <br /> I hereby certify that l 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 LocalliHealth District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> 4 "1 certify that in the performance of the work for which-this permit,:is issued;, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." ,� <br /> Signed - ----------------- --- -------- ----------- ---------------------------------'------------- <br /> Owner •,� <br /> BY ---- - �--�- ------- �_� --------------- ------- Title ...... .- <br /> (If other than owner) F -, •-;; .= <br /> I FO DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.------ - -- -- -------------------------- ------------------ ------------------------- ---- - ---DATA ----1�----�-'-,°- "' ,� <br /> BUILDING PERMIT ISSUED . -------------------=--------------DATE - ------------ --------------------------- <br /> ----I---------- -�„ _ <br /> ADDITIONAL COMMENTS -- --------------------------- --------------------- -------------- <br /> ------------------------------ --------------------- ------ <br /> ' ---------- --------------- <br /> -----�------------------------- ------- --------- ----------- -i -------------------- --- -------------------I------------------------ <br /> - ----- --------------- <br /> = ---------- -------- 2 <br /> Final Inspection-by- -- ------------ _t` r- ::----------- ----------1-- ---------- Date ' - - <br /> ------------ ---- <br /> e ; SAN JOAQUIN LOCAL HEALTH DISTRICT t <br /> E. H. 9 1-'68 Rev. 5M - - <br />