Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. �.-/�� <br /> ------ --------------- --- - --•------------------- (Complete in Triplicate} ----------- <br /> ------------------- --- --------------------------------- <br /> This Permit Expires 1 Year From Date Issued Date IssuedS__,,2 7__70 <br /> DS'I —rso-[S <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 -- - _-:-- ��---- -- US TRACT -- - /-------------- <br /> Owner's Name .__ --------Phone ------------------------------------ <br /> Address C� - <br /> -----e -r�--------------- ---_--------------------- City ------------- <br /> Contractor's Name License # Phone <br /> --------- ---------------------------- <br /> Installation will serve: Residence ❑Apartment ouse Commercial:❑Trailer Court ;❑ �+ , <br /> Motel "Other bk��-_ ---------------------- 1 <br /> Number of living units:__________ Number of bedrooms ------------ <br /> Garbage Grinder ___________ Lot Size __ __ ___ <br /> Water Supply: Public System and name ---------------------------------------------- <br /> ----------------------------------------------------.....--------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;] <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 placed on reverse side.) " <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK ] Size__/Of_S4�r-------------------- Liquid Depth __ ___________________ <br /> Capacity/�l-.--------- Typg'kt'4-_�__ Material__ No. Compartments �-..--•-- I <br /> Distance to nearest: Well _ __�Jr1______ _________________Foundation _____L47___________ Prop. Line ---______ ________.__ 1 <br /> LEACHING LINE Al No, of Lines -----/---------------- Length of each line-----/_(T -------------- Total Length ---/4- <br /> Box _3' r2___ Type Filter Material /Q- '_____.Depth Filter Material ---/1P ''----------------------_...... <br /> Distance to nearest: Well -,f� ____ ------ Foundation __/_+"''__ -------- Property Line _33____________________ <br /> SEEPAGE PIT Depth _--_67_- -_ Diameter _ _ ---- Number ___________ _ Rock Filled Yes,dw No i❑ <br /> �- <br /> Water Table Depth --------------------------------------Rock Size ---� ---------------- <br /> Distance <br /> ------------ -Distance to nearest: Well - <br /> ___________________Foundation -__ - _�_ Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _________________________________-_-._____ Date __-_-___.__-________-_____________) <br /> SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ------------------------- _-------------------------•-- <br /> } <br /> DisposalField (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- <br /> -------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------•--------- <br /> ------------------------ ---------------------- --- ------------ --- ------------------------------------------------- <br /> - - - - - -------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> ! hereby.certify that I-have-prepared-this—application and that the work will be done in accordance with San Joaquin r <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 /> "1 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 become subj o W Lt's C nsati.on laws of California." <br /> Signed ------ --- -- <br /> - -----------4MW A- Owner <br /> BY --------------------------------------------------- --- Title --------------------------- --- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY 41 <br /> APPLICATION ACCEPTED BY ----------------------------------------------------- ------- DATE --- ---.Z- --7b----- -------- <br /> 3 <br /> BUILDINGPERMIT ISSUED ------------------------------------------------------------- --------------------------------------------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS --------------------------------------------------- ' <br /> ------------ -------------------------------------------- -------------------------------------------------------------------------------------- ----------------------------------------- <br /> ---------------- -------------- ------ <br /> ------------- --------------------------------------------- --------------- -------------------------- ------------------------------ -- - ----- <br /> - - - - -------------- <br /> -- - <br /> Final Inspection b --------------------------------- ---- - - _Date �------------------------ -•------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />