Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �f/ <br /> Permit No. -/1.---------- <br /> ''------------------------ ------------ (Complete in Triplicate) <br /> 7/ <br /> --- --------- pate Issued --�a :-off <br /> ---------------------------------------------------------- <br /> Local <br /> ------ ------------------------------------------ - --- <br /> - <br /> This Permit Expires 1 Year From Date issued <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 m//Rade in compliance ith County Ordinance No. 5499anexisting Rules and Regulations: <br /> - d%lll.����?� �---- - -, ZD�r�"� �------- ------CENSUS TRACT ------------------------- <br /> JOB <br /> ---- ----------------- - <br /> JOB ADDRESS/LOCATION . <br /> Owner's Name - - - ------ --- - ----------------------------------- ------ ------- -�- <br /> Phone -----�------- ----•-- <br /> Address -� 3s / ------- -- --- ----------- -------------------------------- <br /> CitY �` <br /> -------------"-------- <br /> I -------.LicenseSSS' Phone - 1 ►�' <br /> Contractor's Name .._ - "°' `=" <br /> r <br /> E] Apartment H use Commercial:❑Trailer Court <br /> Installation will serve: Residence <br /> Motel ❑ Other ------ ----------- <br /> F <br /> ----------- <br /> Number of living units:------------ Number of bedrooms --_----_---Garbage Grinder ----------- Lot Size --_- --X44 <br /> Water Supply::Public System and name -------------------- -------------•--- ----- <br /> --------------------------------------------- <br /> ------------_---_--Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E] Peat ElSandy Loam Ig Clay Loam El <br /> -Hardpan - =Adobe°❑--Fill-Material----�--`if-,Y.es;type"—=_-- <br /> { plan,lan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 0 <br /> NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,} y O <br /> PACKAGE TREATMENT { ] SEPTICTANK�' Siz ",S__�5,�-��--ol--------------- Liquid Depth ------�/ <br /> No. Compartments --- -------------- <br /> 4/5a0--- Type ! Material" ! P , <br /> Capacity -- ----- --- - � <br /> Foundation - ---------- Prop. Line ___ GA <br /> Distance to nearest: Well --14-Q--- --- -- <br /> ' 6-------- ----- Length of each line---�D(>----------_--- Total LengthA-_-�-�-�------------- <br /> LEACHING LINE No. of Lines "----- } <br /> D' Bax --©�---- YP 5/- m� - -De Depth Filter Material ----149.-------------------------- <br /> Type Filter Material rte- -- - P <br /> - t S� ----- Property Line. ---`55--------.--- <br /> ea- Foundation <br /> Qistance to nearest: Wel{��_-------------- - <br /> t Rock Filled Yes Q No fl <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number -------------------- - <br /> --------------------- -----Rock Size --------------------------- <br /> •�. Wa#er Table-Depth- ------------------""'" <br /> Distance to nearest: Well ------- ------ ----------------- ----Foundation -------------------- Prop. Line -------------_------- <br /> a'RIEPAIR/ADDITION(Prev. Sanitation Permit# -`-------------------=- <br /> ------ Date ---------- •--------------•------) <br /> --------- <br /> Septic Tank {Specify Requirements} --�---_:.--t-___-. <br /> ------------------------------ <br /> Disposal Field (Specify Requirements) - -'--•--------------------------------------------- <br /> t. <br /> ---------------- <br /> y --------------- -------- -------------------- }....�..r..rra�. ------a--"---------------------------"""- <br /> _ _ - <br /> -' ---- '--- <br /> rT �— <br /> `_(Dr' ng and-required-addition on_reverse.si e)�. _- - �---- i <br /> r application and that the work will 6e.done in,accordance wlth,San Joaquin f <br /> 1'hereby certify that I have prepared this app ' L <br /> cCounty Ordinances, State Laws, and Rules and Regulations of the San Joaquin I:ocal,Health District. Home owner or licen- <br /> sed agents signature certifies the following: s <br /> l <br /> "1 certify that in the performance of the work for which this permit is issued, I s alhnot eri+ploy any person n�such manner <br /> as to become subject to orkman's Compensation laws of CaliFornia.". <br /> Signed -.-_L�� ------ --------------��` -- Je i r, <br /> Owne <br /> ' --------- Title ------------------------- ----------------------- -- <br /> - ---- <br /> (If other than owner) ; 'r <br /> FOR DEPARTMENT USE ONLY x � <br /> APPLICATION ACCEPTED BY . -��------- I' <br /> --------------------------------------------I DATE -----'-"- <br /> I3UILDING PERMIT ISSUED ----- ----- <br /> --------- -------- ------DATE ------------------------------------------- <br /> ----- <br /> '------------------ -------- --------- <br /> ADDITIONAL COMMENTS ----------- ------------------- ----- -- -a <br /> ---- ---- <br /> ------------ -------------=--------------- ------------------------------------------------- ----- ------------------------- <br /> ----------------------- - ------------ <br /> ----- <br /> — / <br /> ------------------- --- - - - -------- <br /> -- - ----------------- -----.Date ---- - ------ - --,-- <br /> Final Inspec ,o -------- ---_� <br /> - - ----------- <br /> SAN JOAO.UIN LOCAL HEALTH .'DISTRICT <br /> s <br /> F_ H. 9 1-'68 Rev. 5M I _ ' <br />