Laserfiche WebLink
iFOR OFFICE L15E: <br /> APPLICATION FOR SANITATION PERMIT <br /> ......... <br /> (Complete in Triplicate) <br /> Permit No. ..`f. ............. <br />........................................................ This Permit Expires I Year From Date Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> J08 ADDRESS/L Cr`j ON1 J p / /� <br /> fwioN . .-. AL 1.-.L��G'!`l �7..t...��S� _/-c : aR CENSUS TRACT ..............:...... <br /> ..:_. <br /> Owner's Name .-... . .�G`5.... .tg!....................•-------- -_--------------- -•---•--.......•.....Phone --•--.... ...................... # <br /> Address .............. .......................................................----................ .. City <br /> Contractor's Name --------------------------------------------------------- ---...------------------.License # .........,-.............. Phone .............................. <br /> Installation will serve: ResidenceigApartment House Commercial❑Trailer Court ❑ SAS' <br /> Motel ❑Other ....................................... .... J <br /> Number of living units:...-.. Number of bedrooms ...Garbage Grinder ..- _A.5.. Lot Size .'. .. ... .. 19 <br /> y <br /> Water Supply: Public System and name ..... l�.,.�A'�-... ? .---------_...-...--............................................Private I <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ -Clay F] " Peat❑ Sandy Loam' Clay Loam ❑ i <br /> Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ............... .............. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be pl�ed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if pub is.sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ) SEPTIC TANK ] Size " ' -- <br /> -..._ Liquid Depth .........--t� <br /> Capacity Ac—c ..... Typ ..- .."'NM. .. Material�90.C4.S .—No. Comp ments •..-.. ..�..._ <br /> Distance to nearest: Well -------,_..1!�C'................Foundation ------ ..... Prop. Line <br /> LEACHING LINE No. of lines ..._-._�a........... Length of each line.------. ................ Total Length <br /> V Box . I-.... Type Filter Material �K. <br /> •_-• - •---. ..._.Depth Filter Material ........ ... ....................... <br /> Distance to nearest: Well ...,�I �........ Foundation .......?IS ------- Property Line .....�.... <br /> SEEPAGE PIT [ ) Depth ---------........... I <br /> Diameter ................ Number ..._......---.--------____-. Rock -Filled Yes ❑ Na (]37 <br /> Water Table Depth ...................Rock Size / - <br /> Distance to nearest: Well ................ .......-.-....Foundation ................ Prop. Line .....-...._.__- � <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................---.------------ Date -.---.----.---------._•------.---- <br /> SepticTank (Specify Requirements) ................____................................. ----------------------•................................ --•---•---.----- 1 <br /> Disposal Field (Specify Requirements) --••-------------------------------• --- _-..-_---- -_---...........................-........-- ------•-------------------- <br /> ............... ....-----.........................------....---------- ----------------------------------------- ............... ........................ <br /> ........... ----------•--------------------- -------------•---...............................-..........................................................................-------•----- <br /> (Draw existing and required addition on reverse side) <br /> 1 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 bec a subject Woyi Ioa ` mpensation laws of California." <br /> Signed .............. A�- .------......, - •-- -----•----------•-------•-- Owner <br /> By ....--•--------------------•-------•--...............................................-..----_------.. Title ---------_ ------..................................................... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... .... ... .................. DATE -.--."�.-:77 4............_ . <br /> BUILDINGPERMIT ISSUED ....... .......................................................................:...:..........DATE ........................................... <br /> ADDITIONAL COMMENTS ........................................•---•---...---•----......._....---•------•---•-------- ..............-..-.......................I.............. <br /> ......_ <br /> . _ . -------••••......--•-----...--- - <br /> ...- t. ..............-•---••--------------------....------------.............. . <br /> ..... <br /> ........... ..............•---- ... ... <br /> •----.......------ <br /> = ----------------------------------------------------------------....................... <br /> Final Inspection by: .---- - 1 ................ <br /> ---------------------------------------------------- -------...---••---•-.........----.,.. . --•----.Date -----------.-...-..---- �. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ti <br /> .. 1 4 94 . 7 179 4 u 1 <br />