Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE: `P ; <br /> APPLICATION FOR SANITATION PERMIT <br /> ( 641ete in Triplicate) Permit o. ..................... <br /> t y. . <br /> This Permit Expires t Year from Date issued Date Issued .....�............. ; <br /> Application is hereby made to the San Joaquin Local Health District for a { <br /> q permit to construct and install the work he .. <br /> described, This application Is made in compliance with County Ordinance No. 549 and existing Rules and Regulationst <br /> JOB ADDRESS/LOCATION .✓z%�/_,.//L�Cl._ l,S... lf'0_cr... r�'� ..lg/hs/f2�)CENSUS TRACT ..................... ... ' <br /> Owner's Name ../�0. ..:�s.. c7 �f'.QfJ� . _ Z- <br /> ......_ .... ¢3 <br /> Phone ._�� <br /> Address ..._..._. o� � _�.... _.. �_...... .. . . city fit........................... ............... <br /> l ; <br /> Contractor's Name -A-------•-------- -----------------------------------License # ._...E._.,.•--`- ------ Phone ----- ................ <br /> Installation will serve: Residence RApartment.House❑ Commercial❑Trailer Court <br /> Motel u- <br /> Number of living units:..__/----- Numberr-of bedrooms __,2....Garbage Grinder _Af V_'-_ Lot Size . aZ «er--...... T <br /> I x <br /> Water Supply- Public System and name..7------ ----------•-•-=------- ...............�.---------•--....__................Private <br /> Character of soil to a depth of 3 feet: Sand O Silt[] Clay ❑ Pea#❑ Sandy Loam o Clay Loam o I <br /> Hardpan Q Adobe ❑ fill Material .--------.__ If yes,type............... ...... <br /> •----• <br /> 11 <br /> {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) C� <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted 0 public sewer is available.wit� ,) <br /> OQ feet �f i <br /> PACKAGE TREATMENT, fy' SEPTIC TANK ] S►ze__.-• - . ' __. LlquidxDepth .. ��....,..:.. <br /> CSI ................... <br /> Capacity lv _ Type .r.e.. l Material o. Compartments ... <br /> Distance 'to nearest: Well ................... _: __ i <br /> ----�--...----•--- 11`C-�-!--...__ Prop. Line .---�-¢-------- <br /> LEACiiING LINE No. of Lines -_3-•-• ---.--_- Length of each li -- - -------- Total Length .... .---- •--- i <br /> i `D° Box .k Type Filter Ma#erlal5.. epth I"ilter"'Material <br /> ... f- :f.. ----- --..... <br /> �........ Property Line ...Distance¢Distance to nearest: Well .- ............. Foundation -. :.. <br /> SEEPAGE PIT [ l Depth _ ..._. ... Diameter ................ Number --------- --:_.. Rock Filled Yes ❑ No l <br /> j <br /> 'Water Table Depth .------- ---------------FYI�............. ..Rock Size---............................. <br /> # g <br /> Distance to nearest:Weil .....................•----------:----.-.Foundation .................... Prop. Line ................. <br /> rte-- a r I <br /> REPAIR/ADDITION(Prev.,Sanitation Permit ` --- _.-----------------------�".:-_.,--_.�-- Date .---,>- .......................... <br /> y —---_. t .>7 <br /> Septic Tank (Specify Requirements) .....1-.................... .......:::.... ......................... <br /> Disposal Field (Specify Requirement's) .. - -------- ---- ,::....b_:. :' `............................................................ i <br /> --- ----•- <br /> x� <br /> (Draw existing and Ee ibired addition on reverse side) <br /> I hereby certify than 1 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 Jo iquin Local Health District. Home owner or lite►- _ <br /> sed agents signature}certifies the following: <br /> "1 certify that in therperformance of the work for'which this permit Is issued, I shall not employ any person In such manner a <br /> as to becomes [ect to rkm 's mpensation laws of California." __...... <br /> Signe,/ p <br /> - -- - -- - • ----------------------------.. Owner <br /> $ title .................................l :.� <br /> Y --- <br /> -------- ------------ .',. <br /> (if other than owner) �. . <br /> FOR .DEPARTMENT USE ONLY, , <br /> qV <br /> APPLICATION ACCEPTED BY . �_: <br /> DATE --. .......+ DATE ..............._..._.....----•---•---.BUILDING PERMIT ISSUED _---------- = <br /> ADDITIONAL COMMENTS ------------------------ -•----------------- -- ---............_ <br /> ..--•--------------- <br /> -•--- ---­----------- ----- <br /> -- --------------...._.._.__.......... ._._.... . ------------- .................................---------------.....__---- <br /> finalInspection by;.---- G'=.... _..._ .......... ..:..................................---.--.----------------.._.Dote .r7l. ./..�----------- -----•-- <br /> tll 13 2h 1-6 i SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />