Laserfiche WebLink
E FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. ..7 ............. <br /> � 3 <br /> ..............................IThis Permit Expires i Year From Date Issued Date Issued ..7:71tl <br /> Application is hereby 1 3 3 0 o- ok <br /> A <br /> pp y made to the San Joaquin Local Wealth District for a permit to construct and install the work herein <br /> described. This application is made in compliance with Coun y Ordinance No, 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIQ �. S <br /> r5..7 CENSUS-�'RACi ..... <br /> .. - - t­ ,*.---.. <br /> Owner's Name ........ . . ... ,�....c.�-f.. -. _....... ........Phone ..... . <br /> Address .......... _... . _ .-- <br /> f . .. ..... - City ... <br /> Contractor's Name ............. &����7.... <br /> .........---.... . ..... . ... �.. ..L►'cense �-�.- .3 hone ... <br /> Installation will serve: Residence 0 Apartment Ouse Commercial 'j]Trall1er Court 0 <br /> �t..1 �4 <br /> r Motel El Other <br /> Number of living units:............ Number of b6dro8ms ...:.._ ''Garbage.Grinder-::_:-_.—.:-Lot-Size, .................. <br /> Water Supply:-Public System and name ... } <br /> ......-•---...-••---••---.-•--......---•...._.__...._.._.............................................Private ❑. <br /> Character of soil to a depth of 3 feet: Sand l] Silt I] Clay ❑ Peat[] Sandy Loam 0 Clay Loom Q <br /> Hardpan ❑ Adobe 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 � �_ . ......................... Liquid Depth ....�/... ......... <br /> -1��] SEPTIC TANK �ae..... .._ _ <br /> Capacity l ?.. Type ••.,•••- Material.. r.... No. Compartments ... - .:....:„.. — <br /> Distance to nearest: Well --------------••--,------•..........Foundation .._ --------- Prop. Line ...............{� <br /> q LEACHING LW!~ No. of Lines .......... Le�ngth-of.: ach line.._.....�0--•--•-- �TotdlxLen Length .............. <br /> 4 .............. <br /> . y _ <br /> k <, D' Box ............ Type Filter Material ._ .` ._.Depth Filter Moteridlk ../8 ............................... <br /> _ <br /> t <br /> Distance 4a nearest: Well .y_.:.�.{_ r_ ,'Foundation - r .. p rty� ................ <br /> �.Q:._::? ._ -Pio e Line <br /> ;SEEPAGE PIT E j Depth ...!�?...---..._. Diarribter Number ..._._....___l............. Rock Filled Yes [ No ❑ �� <br /> .. <br /> Water Table Depth { Rock Size <br /> r <br /> Distance to nearest: Well --------------• --------. Foundation -./.Q_._f'r----- Prop. Line ... ------.--.... `}'x <br /> REPAIR/ADDITION(Prev. Sanitation Permit�# <br />� ..................................--........ Date .................................. <br /> Septic Tank (5 eci Re uirements "`”" "" "" ---- -� <br /> P fY q I .._......... .................................... ....................... -: .... .-----............ <br /> Disposal Field (Specify Requirements) <br /> ------------------------- , <br /> 4......................_---- t L <br /> •--------•.............. <br /> -------------------- <br /> ••----•--•----.......................................... <br /> .---------------------- <br /> *...... <br /> .------------- <br /> (Draw existing and required addition on reverse side) <br /> '1`hereby certify that I have prepared tris,application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State lows, and Rules and Regulations of the San Joaquin local Health District. Horne owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which thisermit is issued h <br /> p , I 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 /> r <br /> By _ .... <br /> . ._ - ---------- ..................... Title .. ................ <br /> (If of r than owner) <br /> FOR DEPARTMENT USE ONLY <br /> BUILDING <br /> APPLICATION ACCEPTED B.. ...�=..�3 DATE..•_.- . :.........__ <br /> J, f <br /> BUILDING PERMIT ISSUED .................• ....-•------••• ...........--•................_ DATE <br /> ADDITIONAL COMMENTS ..................:.............. ..... <br /> .........................................•.................. i ,.......__... -n ..............................------•...............I......--- <br /> -• ..;.. <br /> ........... ..................................... • ......... • -•••-......__. <br /> �............... ...--------.. <br /> Final Inspection by: <br /> G .......................... -•----------........-•-•••......••..Date ..f 1 :.::::- :::..:::: <br /> . SAN JOAQUIN LOCM; WEALTH DISTRICT [L <br /> E. W.1_3 24 1-'68_Rev. 5M - - 7172 3.,H .0 <br />