Laserfiche WebLink
.FOR OFFICE USE: <br /> r APPLICATION FOR SANITATION PERMIT <br />,.. ......--•.. .................... Permit No. ..7.Y-`._�`�� <br /> (Complete in Triplicate) •. <br /> i.......... .....•-...._..•-•---._......._............... d f7 7 <br /> This Permit Expires i Year From Date Issued Date Issued _141- -.-f <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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> t !/ - p <br /> JOB ADDRESS/LOCATION ....................------_ .. _7- ........ �- - /1. CENSUS TRACT .......................... <br /> Owner's Name �.L1.Cr..G._.�.k--------- .......... <br /> ... Phone <br /> Address <br /> ....................... - �Y --�--... A!y-7_C-_5�4.......................................... <br /> Contracts <br /> is Name . . ...License Phone <br /> Installation will serve:, Residence X-Apartii w H6used''Comrrtercial ❑Trailer Cou—❑ <br /> Motel ❑ Other -------- ------• ...... ------------- <br /> Number of living units:...,..._.. Number of bedrooms _...Garbage Grinder .... ....... Lot Size .. .X.... .......... <br /> Water Supply: Public System and name .....`._' - -:----._..- --Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom Clay Loam ❑ n� <br /> " Hard ori 1"Adobe j i:i _M' teri-I ._:._------ If es, e ' �" <br /> P ❑ ❑ ,� Y h'P <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) AS <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,( <br /> I <br /> PACKAGE TREATMENT [ SEPTIC TANK[ ] Size.............................. _.......----... Liquid Depth .............. <br /> Capacity .. . ... . ...... Type -------...-......... Material.............. No. Compartments _----_-_---_- <br /> Distance <br /> ----_. -_--_....Distance to nearest: Well . ..-------------------------_----Foundation .................... Prop. line -------•----._._...-. <br /> LEACHING LINE [ ] No. of Lines Length of each line Total Length .-.-._...................... <br /> 'D' Box .._... . . . Type Filter Material ................:...Dep�t-tlter Moterial _--- ----------- <br /> Distance to nearest: Well ........................ Foundation ........_..... ....... Property Line . <br />` SEEPAGE PIT ( ] Depth . Diameter....-- ,-- -,:_:. Number.:;—:­,_—A------- Rock Filled Yes ❑ No ❑ <br />!� Water Table Depth --------------------------------------------•---Rock Size .------- •-•---------------- <br /> Distance <br /> --- ------ <br /> Distance to nearest: Well .................. .......... .....Foundation ............------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------- ----------------------- Date _--.__-_._-____-:-.._----__-.....) <br /> Septic Tank (Specify Requirements) �---------------,__^..---.---._-• .._ <br /> Disposal Field (Specify Requirements) ---•- 1-.�- - /e-�---- -�C.�..-----•--• 0.----•GC!/2)15__ "2 -,c .... <br /> ------------------ <br /> ---------................ ... t..........------. _ .- .r ..------- <br /> J <br /> r : f <br /> (Draw existing and required addition on.reverse sided <br /> 1 hereby certify that 1 have prepared.this application and that the work will be do 'f i_k`accordance with San Joaquin <br /> County Ordinances, State Laws, and Mules and'Regulation`s.o-f the San. Joaquin Local-kea`7th,District. Nome owner or licen. <br /> F sed agents signature certifies the following: ' <br /> "I certify that in the performance of the work for which this permit is issued, I 'shall nouemploy any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .:............ ...................... ... . ---------- Owner l <br /> By : f s <br /> (if other than owner) i <br /> FOR DjEPARTMENT USE ONLY ti , ----- <br /> APPLICATION ACCEPTED BY .- . . ---- ti.-------- ------K.. �- DATE ....k._ &.1q.--•.......... <br /> BUILDING PERMIT ISSUED .... ..... ............. ...... ,....... y..----..._-.-.._.._. ._..........r:;".DATE .......---......_.......... ........... <br /> ADDITIONAL-COMMENTS . <br /> .- - :.-.-.- - _ --, � -,. _._ <br /> .............. ... .... ............. <br /> ..--_-._...-- .. _......_..__.__._.-...-........_.-__.-.--......._...........--.--.........................4:._•T:...\.1.____...-: "-. . <br /> - <br /> Final Inspection b ----------------Date ._.-G�: -..... .. ...:__•-------- <br /> i SAN JOAQUIN LOCAL ;HEALTH .DISTRICT <br /> I - <br /> i E. H. 1.3 24 1-'68 Rev. 5M 7/72 3 ,K <br />