Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> .........."...............................•..... Permit No. ....Z3.-/..: <br /> (Complete in Triplicate) <br /> ' <br /> Date Issued ..1.:"....:,_... <br /> - .-.-.-- „-•, This Permit Expires t Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per <br /> 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 /> iF s's � "—_-f ... CENSUS TRAC.T.... <br /> 4................. <br /> JOB ADDRESS/LOCA7i 1V..„...:...y' .. . .: .Phone ......; ........................ <br /> . . .:Owners Name . --z- city: ......-- •- ................................................Addre <br /> Contractor's Name ....... .:. s-� pC:....:.::. •.. License#/. ..... Phone :.. :................. <br /> ... <br /> lAstollotion will serve: Residence-EApartment House 0-Commercial Q7rallerCourt ]: ' <br /> Motel Q Otho....... ............ .. . _• t "7,l c.t2�5.. <br /> i u <br /> Number of living units:---- Number of bedrooms .../......Garbage Grinder..^...__:..._ Lat Size 1••-ate” <br /> Water Supply: Public System and name .......................... :...........------. •r•••.-::--. •. .. .................. <br /> � Private <br /> Character of sail to a depth of 3 feet: Sand[} ilt(] ` CIO—j= - �P`eat j] Sandy Loom.0 Cloy Loam.D_r <br /> Hardpan Adobe 0 Fill Material ............. !f yes,type ......................... .. : <br /> (Piot plan, showing size of lot, location. of..system in.relotion_to wells, buildings, etc. must.:be .placed;on.reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit pefrriitted if 'public sewer!s available within 200 feet,) <br /> PACKAGE'TREATMENT ( � SEPTIC TANK ] 5ize. .....:..................:..............:......'.Liquid Depth . ...................... <br /> Capacity -- Type ... ._.... ...... Material- No. Compartments ;.: :':.,;...........:. <br /> Distance to nearest: Well ...................... " � Foundotio _..•......_...._...... Pr p. n .... , .....•.._..�. <br /> t .............:............_. <br /> LINE Na. of. lines :_;.._--._.. Length of <br /> each 'line.......... .....n_. .. .. Total Lerigth'Li e <br /> !,a,VLEACHiNG ( j _.. .. .. s <br /> t .D' Box --•-------L-Type Filter.Material ....:.... ...... Depth <br /> iter t ::.... .::....:: .:"...::..... <br /> D 'Filter"Material" � -•-: <br /> Distance to nearest: Wel! Foundation_......:...:::r:.. __ ,�Psope ;;Lir►e;- _= -.--__:._..... <br /> SEEPAGE PIT '( j .. Depth ....... . <br /> ...... :. .. .. Diameter '.._...:...:�.::_ Number : <br /> ..............._ :...:.:....,Rock F:lled_;.Yes ❑:. No {] <br /> ! Water Table Depth.... . ...:.... .. .. .. .Rock.Size ................ <br /> .Foundation oi?•, <br /> c Distance to nearest: Well ......:....... ...........r......_ Pr Llne . <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ....:........: .......... .......... Date� ......- ----.•...? <br /> Septic Tank (Specify Requirements) ................+.._.:.- .....-• ...-----..:......o:. . ............. ........ <br /> �........_.. ................. <br /> Disposal Field (Specify Requirements) ... �� --- '° `"`; ✓"` '�► X ........................................ <br /> y 27, f.� _... <br /> ..... <br /> .. ......_.. <br /> ........._................. ..:.... ......_ ................... . ........... ..... ... .................' <br /> ._ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this opplicatioa•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 HealthDistrict.Home owner"or licen- <br /> sed agents signature certifies the following: �. ., , ..... ' ....._ i. _L.... '. ...."._. ..... I <br /> I "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 subject to Workman's'Compeasation laws of California:' , <br /> Signed <br /> . ..... '.... .. : ; _... .... - Owner .................... <br /> . <br /> :.,..' ..._.:.. <br /> -• 'By •... ......... 44 <br /> ......................... Title . . <br /> (!f other.than-owner} <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPT - <br /> ED BY .�• . _..... DATE :I�.:"!�.'.73... .............. <br /> .. ..... .... ..:.. <br /> BUILDING ,PERMIT ISSUED .....:.:..:..:.:: .--• ; <br /> _.. DATE <br /> ADDITIONAL COMMENTS ........ •---•-......•--- ' • . ... ....`. .. .. :. .. <br /> ...•........... ......... ... . .... ............ .._.._.. .......-.... -. .......... .. ...1...: . .•�........... .. ..'A. .. !. .. ..........:t.:.................._ <br /> _ �- ....... .. .. .. ....... <br /> ................ ......... ... ... .. ' <br /> :........ ....: . . .. '._. ... ... ..... .. . . :... .........:...Date .' .. ? .-...._: <br /> Final Inspection by: ... �!.. ''"� .c .. . .................. 4. I <br /> .. ._..... . . <br /> SAN JOAQUIN LOCAL HEALTH DESTRICi <br /> c u L3 24 i_.cQ ae.. cru 7/723-M / <br />