Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. ..T~ :..T 7-3 <br /> This Permit Expires 1 Year From Date Issued Date Issued ... .. 7..3... <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 /> JOB ADDRESS/LOCATION .......-��32-_Shippee Ln. CENSUS TRACT .--------- .--•--. <br /> ................ ................ . .......... . . . <br /> Ow—n- - - Jo Abdallah <br /> wner's Name ..................... ....................................,......_...............................Phone ..9.31—.-— 1-0.............. <br /> Address ...........Qa- e....•• ---------------......................••................-------------------- City ----------Stk7n. ...................... <br /> Contractor's Name B:.aakard!_s._,S.9p-ti-o---..`a]q-k................................License # .--.-.-.__;2689.5]Phone .....A6Jn7.QA8.... <br /> Installation will serve: Residence]] Apartment House C] Commercial ❑Trailer Court <br /> Motel []Other ............................................ <br /> j <br /> Number of living units:..--.l --- Number of bedrooms ......Garbage Grinder ------------ Lot Size --------- 11__a.Crea.._....._.. <br /> Water Supply: Public System and name ................. .....................................................................� ............Private <br /> Character of soil to a depth of 3 feet: Sand El Silt❑ Clay ❑ Peat❑ Sandy Loam',❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe E] Fill Material ............ If yes,type ............................ <br /> iplot plan, showing size of lot, location ofsystem in, relation to wells, buildings,.etc. must be placed on reverse side.{ <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avoildble within 200 feet,} <br /> F v <br /> PACKAGE TREATMENT [ ] SEPTIC TANK T ] Size................................................ Liquid Depth ....................... <br /> Capacity --=----------------- Type ..------. �....... Material.......... 1 �No. Compartments .-.....r ....:..... <br /> Distance to nearest: Well ....................................Foundation .........t............ Prop. Line ...................... <br /> LEACHING LINE 1c] No. of Linds _1------------------_ Length of each line-------1.t<p_!..._.......'."Totol Length ......401 <br /> D' Box ...] ... Type Filter Material 2Depth FlltYi 7wriol _.----1 <br /> Distance to nearest: Well .. 0 ................ Foundation ....,].:0*-..--_---_.- Property Line .....4a ............ <br /> SEEPAGE PIT IX) Depth ---....2 '-..... Diameter ..._4.8'!... Number .,. ----..1.-_--__-.-. Rock Filled Yes . No 0 <br /> • Water Table Depth...................9GI......-.................RoSk Size -----2......................... <br /> ^� <br /> Distance to nearest: Well -----.:2.Q0...........................Foundation ......4W....... Prop. line _... 0 r.......... <br /> REVAIR/ DD[TI Nlrev. Sanitation Permit# ............................................ Date .................................. <br /> SepticTank (Specify Requirements) --------------------------------------------------•--......--.......-----------.-.-•--------...-.-...-..---......---------------.--.._...--- <br /> Disposal Field (Specify. Requirements) ------- ...&...4.8X..2_5t___Pj t--.---.----•------------------------------------ <br /> 4 I <br /> ................................................---------------------------------------------.--------------.........................__.-.._...--------------............................................ <br /> (Draw existing and required addition on reverse side) <br /> I 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 /> as4o-become subject to Workman's Compensation laws of California." <br /> Signed ....................................................... ......................................... Owner <br /> By ....... ....... _ .. ' > ......... xitie ........Cori-tr-a( for--------------------------------------- <br /> (if other than owner) <br /> POR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ....... ... ................................................................ DATE .. -. _.-. �.... <br /> BUILDING PERMIT ISSUED ......... ......... ..:..... . ._.-:..-•..-•-•--..DATE ......-------•--•-•---••......••••.....I... <br /> At�)ITIONAL C ENTS . ------------------------------------------------------ <br /> .....................•-------------------------- --------•-----------......---•--......................... .......................................................... <br /> .................................... --•-- . . ..................................................... <br /> FinalInspection by: .... . . --•••• • . ... . .......................... ......................_--.-............................Date ....... <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 13 241•'68 R _ 7/72 3 M , <br />