Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
f <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----_---- 1 <br /> ------------ -7--------- �^ Permit No: -------�.--i;T0 <br /> e4 (Complete in Yripitcate) <br /> --------- ------ • A <br /> , Date Issued 21,� .-Z O <br /> ______________________________ ________________ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Lochl Health Qistriet for a permit to con'strucYand install the work herein <br /> described. This application is made in compliance with ounty Ordinance Nok. 549 and existing 12ules and Regulations: <br /> JOB ADDRESS/LOCATION -..ft - --p------- ---�-y---=-� -------------------- <br /> ----- <br /> -_.l..------CENSUS TRACT .. <br /> Name - �9i -- .[ �? � <br /> Owners Nam * ��`� �.,� ' # -----------Phone - --------------------------- <br /> Address . "O_�a"' 657 r-�h_���'.�.,.».".�..'w_....... f� <br /> -- City o <br /> Contractor's Name -------�Q�'�_---/.�.�.�'����r.----------------------------------License# ."Phone ......................... <br /> Installation will serve: Residence ❑Apartment House Commercial ❑Trailer Court ',❑ <br /> Motel ❑ Other --------------= <br /> Number of living units:...:... Number of bedrooms�--`.-...Garbage Grinder ��.�Lot Size ..� L�...�._�CT�._.._ <br /> Water Supply: Public System and name ----- ---040_-- <br /> ................ .......Private ❑ <br /> a <br /> Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe Fill Material ------------ If y es,_iype,.... -- ------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etcmust be plat#cl"bn$ reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200;feet,)' 0 <br /> PACKAGE TREATMENT ( ] SEPTIC TANK f ] Size.........._. � Liquid Depth -�----------------------- <br /> Capacity <br /> ................... . <br /> - � <br /> ---------------------------------- - <br /> Ca aci . Type -------------------- Material-. ) <br /> P tY ------------------- Yp ------ - -- - .No. Compartments] ------•------•---=---• <br /> � � ) <br /> Distance to nearest: Well ----------------------- ------------Foundation - --------------.--- Prop. Line ....._.......:_------- <br /> --------- <br /> LEACHING LINEQ' Box nes ------------------------ Length of each line-------------------- ------ Total -ength ..__^ <br /> ' ------._ Type Filter Material ............. p A <br /> E ) <br /> No. o i Depth FilterI <br /> Material . . .__..#....... . ................ <br /> fI Distance to nearest: Well ------------------------ Foundation ------------- --------- Propirty Line .-__-..-_.. _.¢!"._._ f <br /> SEEPAGE PIT [ ] Depth ---- -------------- Diameter ---------------- Number ---------------------------- FilleAY s ❑ No )o <br /> Water Table Depth --------------------------- --------------------Rock Size •----------------••-- <br /> Distance to!nearest: Well --------------------- .-.--Foundation .._..._...._.._.... Prop. Line ....-..__'.. ..:.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit e# -------------------------------------------- Date ----------------- .----...-)� � ` •'' <br /> r Septic Tank (Specify Requirements) ------- f '= �°" .. .. 1 <br /> Y <br /> --------- -- <br /> Disposal Field (Specify Requirements) ---- -- ( .--.---- ------- �. -- _---- --__-- <br /> - �-° --------5" -------� 1 L----------------------- -- � _ --- --------- <br /> ---------------- <br /> ------- <br /> ---------------- --- -------`�- -------------J--------- <br /> (Draw existing and required addition on reverse side)'0 <br /> I hereby certify that I have prepared this application and that the work will be do�ie in accordance with San Joaquin <br /> County Ordinances, State Laws; and Rules and Regulations of the. San Joaquin Local Hta'Ith Ditict:Home 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 shalt netfeenplby any person in such manner <br /> as to become subject to Workman's.Comp ation laws of California." <br /> Signed -------- ------------ - ----------------------------- - --- -------------­--•_........------ Owner <br /> I <br /> By -------------------------- -------- ... ------------------------ Title ...-- �4 h -------t -------------------- I <br /> (If r than owner) <br /> FO EPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED BY ... <br /> - -- -- ---- ----------------------------------------------------------- DATE --------- ' <br /> BUILDING PERMIT ISSUED ------------------------------------------------------ ------ ----- ----DATE <br /> ADDITIONALCOMMENTS --- -------------- -----------------------------------------------------------------------------------------------------''------------------------------_----- <br /> c. <br /> ------------------------ ---------- ------ ------------- --------------- ------------- - ------------------------------- <br /> ------------� = = _ i <br /> - ---- ---- <br /> ----- -- - -=-- - -- -- - - - - <br /> Final Inspection by: . Date ....c --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT �M� a <br /> E. H. 9 1 '68 Rev. 5M _. 4' <br />