Laserfiche WebLink
FOR'OFFICr- USE; <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) r;-Permit No. .7.4 <br /> ....... This Permit Expires 1 Year From Date Issued Date Issued .5..`7" ;9" <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/LOCATIO / yea � �; <br /> ._......................'.._./ _. CENSUS TRACT <br /> Owner's Name _........ <br /> r.... �J•�'�,C). ..Z4.1 <br /> : .. ? 1 .. . _...... <br /> �y� ................................... <br /> -----.Poe . <br /> Address ............. ,��d�... �lj�/`J.......I City ... ...... <br /> Contractor's Name <br /> License # l,J Phone� ,JG � l <br /> Installation will serve: Residence Apartment House 0 Commercial ❑Trailer Court 0 <br /> Mote 0 Other <br /> Number of living units:........ . Number of bedrooms .......Garbage Grinder __---___._ - Lot Size .....:.............. <br /> Water Supply: Public System and name .._ ................ va <br /> ---------------�. ---------;ry---- -_..-;- .... •-••........__._.Private <br /> Character of soil to a depth of 3 feet; Sand Silt[] C y�[I Peat C] Sandy Loam fl Clay Laam ❑ \ <br /> Hardpan ❑ ' Adobe Fill Material - If yes,type ...................... <br /> -� <br /> (Plot plan, showing size of tat, location of. system in+; elat'on'to wells, buildings, etc: must be placed an reverse side.) <br /> NEW INSTALLATION: ` Q <br /> (No septic tank or seepage pitipermitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK.f ] e Size......................-------------------------- Liquid Dep th ........................... <br /> Capacity ....------------_- Type ..................... Material.---------............ No. Compartments 4 x <br /> Distance to nearest: Wel! <br /> ..--;•-------••.....................Foundation ........................ Prop. Line <br /> LEACHINGIINE [ I No. of lines Length of erir[i "`" .. ot <br /> otal Length. <br /> 'D' Box ............ Type Filter <br /> Mbterial -_.-•Depth Filter Materia! <br /> ......... .-_._... <br /> .......... <br /> st: � " ....n................... <br /> .........41. <br /> - ell• .... I;-__neare ;`3 ' _._.......... ......_...._ Property Lie ................... <br /> SEEPAGE PIT <br /> [ ) Depth -------------------- Diameter................. Number ............. ......... Rock Filled Yes ❑ No �] <br /> Water Table Depth <br /> ...................Rock Size <br /> Distance to nearest: Well ........................................Foundation ...........:......... Prop. Line ...................... f <br /> REPAIR/ADDITION(Prev'. Sanitation Permit# ..._------_------__ .. Date ) f:- <br /> Septic Tank {Specify Requirements} ............. .....___...._. : <br /> -------.--- <br /> Disposal Field {Specify Requirements] ..... <br /> --------------------------­­..................I....... ...••----....---. ------------ --•-................... <br /> ---------- -•--------------• - ...........•-----------------...................r..............................._... <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 /> as to become object to Workman's Compensation laws of California." <br /> Signed ......... ... ............. ....I........... <br /> ..... <br /> .._.._..........._. Owner <br /> ,/ <br /> By -----•--- - <br /> .................................. 4 <br /> Title .._ ..., /�.._.... <br /> I other t an owner} <br /> � ! <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> APPLiCA ION ACCEPTED BY.. .... DATE .... <br /> -•----------------------=- ----------•-••••--....------- <br /> BUILDING PERMIT ISSUED __ .... -__ . ... .................•... <br /> ADDITIONAL <br /> COMMENTS <br /> ........... ............... DATE <br /> ...................................................................---••---- ••---.......I............ <br /> ... I-----•-••.........................I................_.... <br /> Final Inspection by: _. _...... - q .... ...... <br /> ...............................................----•-........--•--•-•-••-••..........-----•.........Date ..� ..!... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. L3 24 1.'68 Rev. 5M <br /> 7/72 3 u <br />