Laserfiche WebLink
5 <br /> r� <br /> kms; <br /> FOR <br /> t APPLICATION FOR SANITATION PERMIT <br /> 1 <br /> Permit N -------- <br /> 'it .... <br /> oitrpleYe in Triplicatel <br /> y� Date Issued..4p.-----.-_._.. <br /> .......... �ris�ermit�xpiresa Ycarfrom-0atelssued <br /> Appv' IR .e., the San Joaquin Local Health District for a permit to construct and install the work herein <br /> descri a is app ication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> 4f <br /> JOB ADDRESS/LOCATION......f:.7`U 1...,..P'_..... +�K.. .r-------------- --CENSUS TRACT <br /> ...5... ..•.-.---_... <br /> r <br /> Owner's Name ........ ..... ......-........ ...............-.......------------. ---- - Phone...... -�------- ........ <br /> Address ---------yX�U........ a✓-- ---r.Y. .---} City _?�G_G_..:. <br /> Contractor's Name =------------------:------..License#gef u Phone <br /> jy Installation will serve: Residence[ Apartment House❑Commercial C]Trailet Court F] I <br /> ` Motel❑Other.......................................... 1 <br /> Number of living units:.....r...... Number of bedrooms ....._.Garbage Grinder ..-. Lot Size .............. <br /> L <br /> Water Supply: Public;System and name........................................ .............................. . --................Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ ClayPeat❑ Sandy Loam C❑ Clay Loam.0 <br /> r_t Hardpan❑ Adobe o 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 TREATMEN7 SEPTIC TANK�Q Size ------------------------ Liquid Depth --- .- ---r- <br /> ........ 6` <br /> Capacity./ CtC2-.,.-. Type --- Material----C.VrLcr._�t No. Compartments --- --------------- C <br /> Distance to nearest: Well .___... _A----------------------Foundation,.___ZfJ__1.-_..__Prop.Line__,3_ �_._.. <br /> LEACHING LINE [ ], No. of Lines C+l._.-...---- Length of e/ach li ..../rte�............ Total Length .. !� <br /> 'D' Box __ _____ Type Filter Material _ZA.4gDepth Filter Material ----1��------------------------------- <br /> r Distance to nearest: Well ------- -�. ,;-.foundation ---/0-' Properryi Line ...... - <br /> - <br /> SEEPAGE PIT [ J Depth ji <br /> ........ Diameter _33. Number .___..__. _. Rock Filled Yes No <br /> L Water Table Depth ------------- <br /> - .VL---------Rock Size....................... <br /> 1 { <br /> .-....Fo--u--nd--a--t-i-o-n---....................-]P <br /> ance to nearest; <br /> --r-o--;p <br /> . Line..-...........-........DtWell .... :.::: :.. <br /> REPAIR/ADDITIQN(Prev.8anitation Permit# .. .. . .. ::r.. Date ................----------------- <br /> Septic <br /> ---------------Se tic Tank (Specify Requirements) .......:�.......-- ----------------------- <br /> - - - - ------ -------------- <br /> Disposal Field ISp'ecify Requirements) <br /> ----.. . .. .. ........................ .. <br /> (Draw existing and required addition on rovers..side) ^- -------------- ---- <br /> t <br /> _-S <br /> I hereby certify that;I have prepared this application and that the work will be done in accordance with Son 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 /> il "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 <br /> essublecVt Wo mart's Compensation laws of California.". <br /> Signed ------------------------- --- Owner <br /> -------------- - - Title <br /> ---- -- -- --- -- -- -- ----.. <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLYAPPLICAT . <br /> IOACCEPTED Y - .......................... ........ ..----. <br /> BUILDING PERMIT ISSUED .DATE - -- <br /> _ . - <br /> ADDITIONAL COMMENTS..........---.. <br /> r # <br /> ........ ................................b------------ ------------...................^A.:­._..rf--r......"-"'--"...... ......--'--''---'-''---"---".....-'- ...... <br /> ----- ---.......... ............. y Z-------- -�T------------------ ----------- ------- <br /> - --- -_---.------------:-------- ---------7 .------------------------ <br /> b . 1;17 t <br /> Final Inspection by:- ........:�':Jy?f c.�-- -- --- -- - Date ' - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E,H.9 1-'68 Rev.5M I <br />