Laserfiche WebLink
FOR OFFICE USE: APPLICATION fb- R SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. -7-3.-5.. .-. <br /> This Permit Expires I Year From Date Issued Date Issued .....:............. <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 ......------..k-115 ,...t\r�JQ.eJ..r1-#y..D..............................................CENSUS TRACT .......................... <br /> Owner's Nome ................................ ......... 414 -.-.................-----•-••,-------•---..._......................Phone .................. <br /> . .................. <br /> .....:............................ ... <br /> ,x:10.c < vr..+� <br /> Address ............................... -......�A1�.C.. .. _.N...---------------------•--.... City ...... ._ <br /> Contractor's Name .............. /vz.c .............. ....................................License # .� ~�7 .. Phone <br /> Installation will serve: Residence bd Apartment House❑ Commercial Trailer Court 0 <br /> Motel ❑ Other ...-------- --------------------- ---------- f <br /> Number of living units:...---- -.. Number of bedrooms ....J._--.Garbage Grinder .....--.---- Lot Size ...... -. ........ <br /> Water Supply: Public System and name ----------------•---•--•-------•--.................------------------------------------•• .....................Private <br /> Character of soil to a depth of 3 feet: Sand❑ . Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Material ............ If yes,type ............................. <br /> (Plot pion, showing size of lot, location ofsystem 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....I........................ Total length ............................ <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material .................................... <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ <br /> SEEPAGE PIT O Depth ............... .. Diameter .--_---.•--..... Number ............................ Rock Filled Yes ❑ No i❑ <br /> • Water Table Depth .......--Rock Size <br /> _. Distance to nearest: Well ........................................Foundation .................... Prop. Line .................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..._._....._•............................... Date ......----------------------------) <br /> Septic Tank {Specify Requirements) ...................................................:....•- ....... <br /> r . �•--- 1 19.1 <br /> . . <br /> Disposal Field (Specify Requirements) .......�A)--••--�t-----X-�,......... i - ----....--•-•....................................... <br /> ------------------------••---------....._... . ------------ -------- -•--•--•-----•--•------------------------------------------ .................... .......­­................... <br /> (Draw <br /> -•------------------- -- ---------...........--................----•-•--•---•.....----- <br /> (Draw existing and required addition on reverse side) <br /> 1 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 liten- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -------•-----------------• .... Owner 0 <br /> BY :_.-- .. ..__...I........ Title "1 �..'.... <br /> {lf othe/rtjha �w;ned <br /> FOR DEPARTMENT USE O LY <br /> APPLICATION ACCEPTED BY .... . ........ ... DATE .... . ... .. .__6._-- <br /> BUILDING PERMIT ISSUED ... ........ ............ DATE ........................................... <br /> ADDITIONAL COMMENTS ................. <br /> ---------------- <br /> .......---•----------------• _- _ --..... ........................................ -•--------.._........................................................ <br /> -•---•----•.............. <br /> ... <br /> ..Da r i .> �. <br /> Final inspection by: ... .. ..-- •. --- �......... to ...0 "............. <br /> SAN JOAQUI LOCAL HEALTH DISTRICT �Ic <br /> E. H. 13 241-'b8 Rev. 5M 7172 3 M <br />