Laserfiche WebLink
r � <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> y Permit No. . <br /> -3 �.z. '`e'----- <br /> ----------- �. , <br /> . (Complete in Triplicate) <br /> fa <br /> ------------- Date Issued - <br /> w y y ; This Permit Expires 1 Year From Date Issued + <br /> /Application is hereby made to the San Joaquin Local Health Districtivan a Nomit t and existing Ruuct and lesandthe wort ohere1n <br /> /I <br /> described. This application is made in compliance County <br /> � --------- -------CENSUS TRACT --------------------------- <br /> JOB <br /> ------ -----------------tr <br /> JOB ADDRESS/LOCATION - `��-:�------------ ----- Phone <br /> .. Owner's Name -..- ._ �� � ��` �� � - - - - - <br /> Cit5�oafiol ------------------------ --------------------- <br /> Address ------------- 9--- �.. -License # <br /> --- I - Y <br /> Apartment House❑ Commercial :❑Trailer Cou <br /> rt - Phone ----------------------------•- <br /> Installation will serve: R--.-- <br /> ------------ ------------ <br /> esidence f9J p ours i❑71 ` <br /> Motel ❑Other ---------------------------------------- <br /> � <br /> Number of living units:------1_.. Number of bedrooms _.�------Garbage Grinder --__ Lot Size ___-.-�a-X._�5 <br /> C��f.---_ Private E]Water Supply: Public System and lame _..__. - .- _ - i <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt fl Clay E] Peat El Sandy Loam El Clay Loam:❑ <br /> , <br /> Hardpan ❑ Adobe ® Fill Material ----- ------ If yes,type ------ <br /> in relation to ells, buildings, etc. <br /> (Plot plan, showing size of lot, location of systemwmust be placed on reverse side.) '\1� 0 <br /> NEW INSTALLATION: (No septic:tank or seepage pit permitted if'ipublic sewer is available within 200 feet,) <br /> r / Liquid Depth <br /> ..__--. <br /> PACKAGE TREATMENT Capacity EPTI TANNKK [ ] Size--------.'------------- =--- ------------ <br /> { ff r , <br /> �_ JTYpe -------------------- Material---------- ----------- No. Compartments -----------------_---- <br /> a.'_ r_I <br /> Foundation .. V Prop. Line <br /> Distance to nearest: Well ---------------------------------- - , <br /> ---- Total Len th ----- � ------- <br /> I a�U g <br /> LEACHING LINE [ ]�' No. of Lines —___ ________________ Length of.each line-___. __ __ <br /> i Type Filter Material __--- - _' -----Depth Filter Material ----------------- ---- <br /> 'D' Box �----- - <br /> ,; Foundation --- ----- ----- Property Line ------ --------•---- <br /> k Distance to nearest: Well ..-------- I <br /> Number __-__-- ------ -------- Rock Filled Yesti(] No [ 1 <br /> SEEPAGE PIT [ ] <br /> Depth _- --------- Diameter --* ----- of <br /> y„ �. <br /> Water Table Depth ._. --- w.."-Rock Size,-- g 1 <br /> ! Foundation ----l�t ------ Prop. Line ---- -------------- <br /> Distance'to nearest: Well .�$j- <br /> --------------------,------.------ <br /> REPAIR/ADDITION(Prev. Sanitation Permifi# -------- --------------- - <br /> ---------- Date --------•-------------------•-----) <br /> ! ----------------------- <br /> Septic Tank (Specify Requirements) --------------------------- ----------------------------------------------------- <br /> Disposal Field (Specify Requirements) ----------=----- ---------------------------------------------- <br /> - ---------------- <br /> ----------------------------- <br /> -------------------- - -------------------- --------------------_ ------•-------------------------------------------------------- ----------------- <br /> --- ---- ---- <br /> ------------- ----------- ---------- <br /> f - (Draw existing and required addition on reverse si e <br /> I hereby certify that) have preparedapplication this applion and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws,,cnd Rules and Regulations of the San Joaquin Local Health District. 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 shall not employ any person in such manner + <br /> as to become sub' Wt to W o ensation laws of California." <br /> Signed -. Owner <br /> ---- ------------ ------------------ - <br /> � �. By - -------- ----------- ----------- ------------ Title ---- --------------------------------------------- -------- --------- <br /> ------------------ ------------------------ - - <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> -3 / ------------ <br /> DATE - <br /> APPLICATION ACCEPTED BY ----- i TE ------ - ---- <br /> BUILDING PERMIT ISSUED _.— ------ <br /> ADDITIONAL COMMENTS ?�-- fid <br /> -- - - ------ - - <br /> �- <br /> ---------------- � <br /> ----- - -- - <br /> z3 :- - ------%jai` <br /> - -- --------------- <br /> --------------- <br /> - --- ---- -- <br /> ------ ------ <br /> - - <br /> ------------------------------Y -3 - - -------- <br /> --------------- ---- <br /> ---------- -..Date ---- - -------------- <br /> Final Inspection b ' ----------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. SM <br />