Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />........��'--3.-...�..............•---....__.. Permit No. .`1...�=��� <br /> (Complete in Triplicate) <br /> .......................... ........ This Permit Expires i Year From Date Issued Date Issued .7.. /7s. <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: <br /> JOB ADDRESS/LOCATION ..-. '�. ,._L -..... Cp, ?� ----• .................CEN St15 TRACT ............ .......... <br /> Owner's Name ....... x;..,.�. ---- �"1�C"K ................_.....................................Phone ......................•I............ <br /> Address ..... .......RI& ........-•-•--------..._..------..— City -----.....-•................•. .......-•-------........................... <br /> Contractor's Name ----k4 .......S.A�j./L�.... Vii// _ .....License Phone <br /> Installation will serve: Residence QgApartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑ Other ............................................ <br /> Number of living units:../...... Number of bedrooms ........Garbage Grinder /)e�-_ Lot Size .,�_ 'I..................... <br /> Water Supply: Public 5 stem and name -------- --...----•-•---•................•-------•--••-----------.............-----••--------•- ._.._....Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑. Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ <br /> Hardpan ❑ A8obe4 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 ( ] SEPTIC TANK( ] Size................................................ Liquid Depth ........................... <br /> 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 /> .Z <br /> 'D' Box ._.--------- Type Filter Material ....................Depth Filter Material .._._._..........._................ ......... <br /> Distance to nearest: Well ........................ Foundation ........................ Property 'Line .....-•...........I...... <br /> SEEPAGE PIT [ ) Depth ................... Diameter ................ Number ..._..... .................. Rock Filled . Yes ❑ No ❑ <br /> Water Table Depth ...Rock Size ------ {` <br /> Distance to nearest: Well .........................................Foundation ............. Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# <br /> ................ -----•..................... Date --_---•---• .................... <br /> SepticTank (Specify Requirements) ...............................................................................................................•- ...........--------- .... <br /> Disposal Field (Specify Requirements) ............11V_6: r✓1;,1...........cmvz..--...-_-_. --------_.................. <br /> -'----- °/• 4_V.1Y.. 457t< wf -----_-_--.---------_--- <br /> • . ' "� --. �n✓.�-r ------------------------------------------------------------------------- <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. Horne owner or licew <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 mannas <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ............... ...........•....... •--- Owner <br /> By •.................. . .... '......._ . � ...... ...................... -------- tle ........_... 1 1T.. ......,---.•-_..-.--. <br /> other than owner) <br /> FOR DEPARTME T USE ONLY <br /> APPLICATION ACCEPTED BY ..� .. _..• -----------------------------------------• - DATE ...._ .. ........... <br /> BUILDING PERMIT ISSUED ............... ---..._............... ...--•--.........----------•-.._..................DATE .... ......... <br /> ADDITIONALCOMMENTS ............................................................. ................................................................................................ <br /> - ---- -------- ------------------•--..._ --.....--------------------•------....------ ----- <br /> ----••--•---•.............• <br /> -------------------- -_-...... <br /> Final Inspection by: <br /> ._Date .. ....... <br /> SAN JOAQUIN L CAL HEALTH DISTRICT <br /> E. H.1-3 24 1.'68 Rev. 5M 7/72 3 M <br />