Laserfiche WebLink
FOR OFFICE USE: <br /> \San <br /> PPLICATION'FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete in Triplicate) <br /> This Permit Expires ] Year From Date Issued <br /> ' Date Issued <br /> _ _ _ _ <br /> ------------- -----__--___ ______ ___-_____-___ _____Application is hereby made to theaquin 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 /> JOB ADDRESS/LOCATION -__� L ------�-__pp__w�-y-QV.)w�_R�-------------------- CENSUS TRACT ____" <br /> Owner's Name lj_i L ��� - • ------- ------------------Phone .3 <br /> Address ----- ---97LI------- E--------LVOODWAR------------- •-A City -------f 419-M7 ----------------------------------- <br /> Contractor's Name ----------OI/V� E1 ------------------------------------------------------License # ----- - ---- ---------- Phone _V?_3'7.7657 <br /> Installation will serve: Residence FApartment House❑ Commercial ❑Trailer Courf ',❑` <br /> Motel ❑Other --- ----------------------------- <br /> Number of living units:.._ ._____- Number of bedrooms _ ___Garbage Grinder Lot Size _ _ "C� _____----- <br /> Water Supply: Public System and name --------------- -------- _`__ < I <- -----------.-Private 0� <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ � <br /> Hardpan ❑ Adobe ❑ Fill Material A10--- If yes,type ____________________________ <br /> a <br /> (Plot plan, showing size of lot, location o�stem in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or ;seep pit permitted if public sewer is available within 200 feet,)PACKAGE TREATMENT { ] SEPTIC TANK _ Size6XIO 54-3X_1-_�_-�__-____-_ Liquid Depth _7�r-�-_"-_- <br /> Capacity Q©©____. Type. _ Material Q7N i'><i No. Compartments �__. ........... . <br /> Distance to nearest: Well---------- _--'-'E'-`--------Foundation Prop. Line ., ----------------- <br /> LEACHING LINE ( No. of Lines ___�_---_---;_.__.'Length of each line--------6--D-------------- Total Length .___f <br /> __ <br /> F -FF� 'D' Box/y�5_ Type Filter�MaterialDepth Filter Material --------/_ --' <br /> __.""_. - <br /> QED, �► <br /> Distance to nearest: Well:__'sr __.__^ __ Foundation __ Q___ _.___. Property Line _ "-_.__--"---.----- <br /> r r <br /> SEEPAGE PIT [ ] Depth -------- Diameter 1-0-A-60 Number ---I---------- `_--------- Rock Filled `?es R-­qo i❑ <br /> WaterTable Depth ----------------------------------- ------------hock Size -------------------------------- <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) --------/9------- ------------------ -------------------------- <br /> { <br /> =----------- '4 `r 13aC_ fir_- - _ <br /> ----------------------------- ----------------------- -------------------------------------------------------------------------------------------------------------------------------------- ------------ <br /> f Draw existing and required addition on reverse side) f t <br /> I hereby certify;that I have prepared thin 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 bistrict. Nome owner or licen- <br /> sed agents signature certifies the following: ' _ t <br /> "1 certify in the perform n of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to bec sub) t to Wor 's Compensation laws of California." <br /> Signe ------ '------------------- Owner <br /> 'V t <br /> By Title <br /> B _n <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------- -- . I _ `Vc---- ------------------------------------------------------- -----• DATE --------- Z --7' <br /> BUILDING PERMIT ISSUED _ - '= ----------------------DATE --------- ------------------- ------ <br /> ----. .__ _ _:_ <br /> ADDITIONAL COMMENTS -- - ---- --- ------- - -------------s---------------------- --------------------------- <br /> ------------------------- - - <br /> ----------------------------------- - ----- --- ---------------- ----- - <br /> Finallns e <br /> p e-#iiau_bY ------- ---- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> f <br /> E. H. 9 1-'68 Rev. 5M <br />