Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> - Permit No. _.7...... <br /> (Complete in Triplicate) G <br /> -- --- --- <br /> - Date Issued _3-7A --... <br /> This Permit Expires 1 Year From Date Issued <br /> `fit <br /> Application is hereby made tojhe_San.Joa°quin Local Health District for a per to construct and install the work herein <br /> described. This application is mnde;in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> -� �. + _ I <br /> t <br /> e- <br /> 7­3 L <br /> '-- """" "-----CENSUS TRACT <br /> JOB ADDRESS/LOCATION J llrl�2 _p!� - <br /> Owner's Name 1 1 - �1 ' �='%�` - ��1 _�1,�C - -------Phone •-•--------------- <br /> ,J . <br /> Address / f'_ ----- fF f% .. 'Il _ /\r = City ' ---—'----------- ------------- <br /> Contractor's <br /> ----------- <br /> ����_n <br /> ' �� ' — = � ------ Phone ------------------------------ <br /> Installation will serve- <br /> f�4-+.�-�'�!N�'l�[_----f--0-�=-:-,�'���-�'--------.License # ------------------- <br /> Contractor shame . _ - <br /> e: Residence ❑Apartment House❑ Commercial 'Trailer Court i❑ <br /> Motel ❑ Other _._ 1-/ Ct <br /> Lot Size -_/ -�_ft= � ------- - <br /> Number of living units:-----_""`� Number-of-bedrooms----_________.Garbage-Grinder .___--- - - <br /> Water Supply. Public System-'and name ---------------------------------------------- ---------------------•----------------------------------------Private 0� <br /> Character of soil to a depth of 3 feet: Sand❑ Silt-0 Clay ❑ Peat❑ Sandy Loam '❑ Clay Loam <br /> Hardpan j] Adobe j] Fill Material_-A_U-_If yes; type ----------------------------- <br /> (Plot <br /> - ---------------------(Plot plan, showing size of lot, location of sysfe'm in relation to wells, buildings, etc. must be placed on reverse:-'side.) <br /> NEW INSTALLATION: (No septic Yank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREAT.MENTr:fl SEPTIC TANK [r] <br /> Size- -- •-!_______a---------------------- Liquid Depth _-f;5----- ------,----- <br /> -- -- - T epi 1 r "a ------------ <br /> Distance <br /> ....... <br /> Capacity __.�1 _Type t- _-5i-_ Material f_ -__-r_Z.____ No. Compartments <br /> Distance to nearest. Well ------------------------------------Foundation ----- Prop. Line <br /> -------- <br /> __. _ ._-__ <br /> LEACHING LINE [' <br /> No. of Lines ________ !--:__----- Length of each line � �__ = --- Total Length ____ -r��-__.. _. <br /> R / _ .. 3�1 C I- <br /> ii <br /> 'D' Box +&_-C?____,Type Filter'.M'aterial �l________-�--__Depth Filter Material -----l9--------._ ------- -------- <br /> &-- -� Pro `� -------- <br /> Distance to nearest: Well --------------` �.�_=Foundation .__ _._-________.____-_- Property Line. _____ , <br /> ,� Depthr / Rock Filled Yes No <br /> SEEPAGE PIT [' Water Table Depth Diameter, �_X "�'Num1e57, <br /> Rock-Si <br /> e}_L_ _ '__�r---, ;7 �✓1it� r <br /> p ----------------- <br /> Wel <br /> - <br /> Distance to nearest: Well,-J-� ��--_fr'�-1--- ---Foundation _(-______________ Prop. Line __.y�___......-. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date ------------------_---------------) <br /> Septic Tank (Specify Requirements)-7-------------------------------------------------- `-,=--_--- -----------------• --------- --------•-----.-._...----------------------- --- <br /> Disposal -Field (Specify Requirements) ------------_-----------r�­--------------------- <br /> A, - ------------------------ <br /> _ . _ ------------- ------------------------------- - - <br /> (Draw existing and required addition on reverse side <br /> i I hereby certify that I have prepared this applicationand that the'work 'wi(I`he 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 /> r "1 certify that in the pe once of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become' bjectjorkmon's Compensation laws of California." <br /> -_OWrierY_-...__.._Signed {. ' -=-----------------=----------- <br /> - <br /> By ----------- --------------------------------- ----------------------------------------7_T`q-.R- Title ------------------ ---=---------- -------------------- ---------- <br /> (If Pother than owner) <br /> FOR DEPARTMENT USE ONLY <br /> e <br /> APPLICATION ACCEPTED BY --------— + -------------------------------------------------------------- DATE --------------------------- 7 <br /> fBUILDING PERMIT ISSUED-.—:-= — °==--------------------------------------------------- -------DATE ---------------------------•- ........... <br /> ADDITIONALCOMMENTS ---- - --- --- ----------------- ------ ------ ------ ------------------ ------------------•-------------------------------- -------------------------- <br /> ----------- -----•---------------------------------------------------- <br />( ------ ---------=•------y ------ - ----- ----------------------- --------- --- - ------ -------------------- ------_------------- - ----------- <br /> '` _ -- _ __ _ - -- ------------------ _ <br /> t <br /> Final Inspection b . _-- - <br /> 1 -Date ---- � '------- <br /> SAN'JOAQUIN `LOCAL`-HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />