Laserfiche WebLink
FOR OFFICE USE- x <br /> APPLICATION FOR SANITATIONPERMIT <br /> 1111...._.--1 111... Permit No. .7 ....... <br /> .................. ----1 :.................... <br /> (Complete in Triplicate) <br /> - - v <br />..... •. <br /> •. ---•- ..__. Thts Permit Expires 1 Year From Date Issued Date issued ._.......3a.7 <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. 549 and existing Rules and Regulations: I <br /> • ,1111 Q ' <br /> °.IOB ADDRESS/LOC TIO . .. ..? �.. ` 6...C16 e�....# .° e ...,.........CENSUS TRACT 1111...................... ; <br /> q q <br /> Owner's Name s te.►�+ ,. ..... �2 � ..........................................................I............Phone . . u.L..~ .(. . . <br /> Address . c . <br /> ... ................ City o. . ... _ r <br /> 1111.. <br /> ! 1111.. <br /> Contractor's Name __-.. t. ---- - Qom-?-- ,License #'.t?). .�. Phone <br /> t 1111. <br /> Installation will serve: Residence Apartment House Commercial ❑Trailer Court 0- <br /> Motel ❑Other .---•....................................... <br /> Number of living units:...,......_ Number of bedrooms ..----Garbage Grinder ...V.1,0 Lot Size ....�.-�..�.3...Q&X%.4......... <br /> Water Supply: Public System and name <br /> ............Private <br /> Character of soil too depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loom'A <br /> Hardpan Adobe[J Fill Allnterial ..__...-`.- If yes,type ...........1111 --•- <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: INo septic tank or seepage. pit permitted if publicC�sgwer is oval#able within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK[ ] Size......- - --6. ........--•11 11..-• 4 P ......................... 1 <br /> ........ <br /> q Liquid Depth <br /> Capacity ..j.���..__ Type (�. ..�,.�IMaterial_.��(�tNo. Compartments r.�,._. <br /> 1111 <br /> Distance to nearest: Well --------- .. ........... :A.�...�r Prop. Line .�..6 <br /> t � r <br /> LEACHING LINE [ ] No. of Lines ... � ...-1111--1111-- Length of a ch line..:. .............. Total Length ... ~t.��. .........z <br /> p <br /> D' Box Type f=ilter Materiall .< Depth -Filter Material ............................ <br /> 1 <br /> Distance to inearej. Well ...... '.© ....'`-Foundation 111.1................... Property Line ......................-. <br /> SEEPAGE PIT [ ] Depth ... ,,5.------- Diameter ___ ._�u_.._ Number 1111._:,A............... Rock Filled Yes 0, No.oe <br /> Water "fable Depth ---------------------------------------.........Rock Size ................................ 4 <br /> t b <br /> Distance to nearest: Well ----- ............Foundation -----------......... Prop. Line ......................1 -� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------•-----_------------------- - Date ..-_.---.-... .................... <br /> Septic Tank (Specify Requirements) ...:............ <br /> -----------------------1 - _............... <br /> .. <br /> Disposal Field (Specify Requirements) ----------------- •••--------........... .............................. ----.._..........:.--•-..............1.1.111111..- ,"(V <br /> -- --------------------------------- <br /> ------------- -------- ------------------------------- - --------------------------- ------------------------------------------•-•••----- -•---- --------..:........................y-:........ <br /> (Draw existing and required addition on reverse sidel <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. Nonce 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 sholl'not.employ any person in such manner <br /> as to become subiect to Workman's Compensation laws of California." <br /> Signed5fi'f0_ih___ <br /> •- - --------------1111...-- .----1--- ------------- - Owner d <br /> gYTitfe .. 1111.an owners � � 1 <br /> R DEPARTMENT USE ONLY <br /> DATE 11: 11/ <br /> APPLICATION ACCEPTED BY --- . .......•. L rr 7 <br /> BUIi_DING PERMIT ISSUED'__-••-----------------• --- -.-.------------------. ---------------------------...------------ -DATE ---­--------------------­--- <br /> ADDITIONAL � <br /> COMMENTS ------------------------------ 1111.. <br /> --------------- -----------------------------------------------.._...-...----. -------------- ................. ...............- .................... ....... <br /> ----•------------------------- ------ = <br /> - - -1111-- - <br /> ------------------1111...1111----------------------------------------------- ... <br /> Final Inspection by: ..- ..----- <br /> .-....--•----------------------- -----------Date .......... <br /> EH 13 2h 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />