Laserfiche WebLink
i FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT !- <br /> �,�� <br /> ---- ------------------------------- .7a--`fG� J. - <br /> - ------------- <br /> (Complete in Triplicate) Permit No <br /> ---------=----------------------------------------------- <br /> --------------------------------------------------------- This Permit Expires i Year From Date Issued Date Issued - -- --"�d. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to ' <br /> (exi'sting <br /> sand install th work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and Rules and Regulations: <br /> JOB ADDRESS/LOCATION .--Q-a---�--�----- Al <br /> -- 4?------ 4-Vim'-----------------------CENSUS TRACT ------------- ----------- <br /> Owner's Name9---------------------------------------------------------- -------Phone -------------------------------•-•-- <br /> Address ----------;—�19M_ V -----------------------•------------------------------------------._..-_. City __Z5` <�/A/--------------------------------------- <br /> Contractorlt Name --1 . ___;S,E r/ ------1$Z77—F-----------------------License # 177:e__�J Phone <br /> Installation will serve: ResidenceX Apartment House❑ Commercial ❑Trailer Court ',❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units:....�___-__ Number of bedrooms _v_2---_-Garbage Grinder -/VV- Lot Size --- -r ----_.-----. <br /> Water Supply: Public System and name ---------------------------------•----------------------------------------------------------------------.------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ <br /> Hardpan ❑ AdobeQ 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,) Q <br /> PACKAGE TREATMENT [ I SEPTIC TANK Dd Size--��-�"� �'�'f�.________ Liquid Depth ------ V <br /> Capacityep - Type�� 6erial"—Wee.Gr'_No. Compartments .2— v <br /> Distance to nearest: Well _----51 l------------- <br /> -_-Foundation ..-- -- ---------- Prop. Line <br /> - --- <br /> LEACHING LINE /� No. of Lines -----1----------------- Length of each line---- - _�-.__-- Total Length --O,d• -_.. <br /> D' Box NO--- Type Filter Material --__Depth Filter Material ...1_ _ _.......................... <br /> Distance to nearest: Well -- 0__(_ ' <br /> hl Foundation ----.��.�_______ Property Line -__- -_-I--__-.__--_ <br /> SEEPAGE PIT [ Depth _ 1_----_---_ Diameter I? <br /> --------- <br /> Number -----------/-------------- Rock Filled Yes a No C] <br /> /� <br /> Water Table Depth -------/4O----------------------------Rock Size ------ <br /> j� <br /> Distance to nearest: Well ��-`•�-----`-------------------•Foundation ... p-.`------- Prop. Line -5..Z: <br /> REPAIR/ADDITION(Prey. Sanitation Permit r# -------------------------------------------- Date -------------_--.--_-_---_-_-----_j <br /> SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------...--------------------------- <br /> DisposalField (Specify Requirements) -----------------•------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------•I------------------------ <br /> -------------------------------------- <br /> (Draw existing and required addition on reverse side( <br /> I 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 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 subject to Workman's Compensation laws of California." <br /> Signed -------------------- --------------- Owner <br /> By --------------- - -------------- Title ---- --------------- <br /> ------------- <br /> (If other an owner) <br /> MENT USE ONLY <br /> APPLICATION ACCEPTED BY -------- -- --- - -- ------------------------------ ---------------- DATE ------- -:--�' d--------------- <br /> BUILDING PERMIT ISSUED ------- ---- - ------ --- -- ------------ ---------------------------------------DATE ------------------------------------------- <br /> ADDITINgL COM ENT, -- -------- --- --- -- - ----- - ---------------------------------- ------- --------------------------------------- ---------- •---------- <br /> f - ---�---- ---------- -- --------------------- ----------------------------------------- -- ------------------------------------------ <br /> -- -- - ------- <br /> FinalInspection bY: ------ ----- -------- ------------------------------------------------------------------.Date --- <br /> N <br /> -N O QUIN LOCAL WEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. M <br />