Laserfiche WebLink
ruk Ur--i--t uat: <br /> APPLICATION FOR SANITATION`„BMIT <br /> (Complete in Triplicate) Permit No. <br /> _--.--_----------_--_-.-.-. ---------_--------------- This Permit Expires 1 Year From Date Issued Date Issued . ...:L� <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 i�rg e in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION . /?ef___..............--._-__CENSUS T ___----_-...-....._... <br /> yam- TRACT <br /> Owner's Name KK// >Ie 2aZ ----- ----- . - --------- ----Phone <br /> Address . -�j6- `f ._,. -- l{2./�Pl - - ------------- City ---/�'�ze" - (�F'''�-------------------------•------ <br /> Contractor's Name -. ..B.0 f --� �wYr<W..License # -24-4_.S.-5O.JPhone <br /> Installation will serve: Residence [gApartment House❑ Commercial []Trailer Court 0 <br /> Motel ❑Other -- ----------------- <br /> Number of liviniunits-----.-...... Number of bedrooms ....',...Garbage Grinder --hn7v Lot Size . --- --_-----. .......................... <br /> Water Supply: Public System and name -----------------------------------------Private B'- <br /> Character of soil to a depth of 3 feet: Sand W' 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,) U� <br /> PACKAGE TREATMENTC SEPTIFTANK ��d d ti.- . _ --Size----./ Liquid Depth -.... <br /> Capacity -2!-P------- Type -v �p <br /> `�Q.�Material_GO-�t�lrr-+-_! No. Compartments -_.�............... <br /> Distance to nearest: Well ...-kQ----------------------Foundation ..fJ`_ Prop. Line <br /> LEACHING LINE [ ] No. of Lines ------�------------ Length of each line.----7.6-----.--.-_--- Total Length _�y�............... <br /> 'D' Box -./..-.--_ Type Filter Material J.9r,_C.SaFto.7`bepth Filter Material ............. <br /> Distance- to nearest: Well ___�/_._--:_ Foundation ____IQ---_...-_--- Property Line ------------ <br /> --------- <br /> -------�............. <br /> SEEPAGE PIT [ ] Depth .__ Diameter -__- x-__._ -__ Number -- ----------- Rock Filled Yes IF No, <br /> Distance to nearest: Well -__-.__-._ _-l*src-_-------------- <br /> Water Table Depth -_--- <br /> ..................Rock Size .......---------Foundation ------------ -- Prop. Line .. -'- ... -'------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------- ----------------------------------- Date -_-.._----------------------__-) t <br /> Septic Tank (Splcify Requirements) <br /> Disposal Field--- - .......................(Specify Requirements) ;--, ---------------------- t--------- ----- -------------------------------------- - - <br /> ...-.. - --' ' . Y <br /> -- <br /> -------------------._'_---------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------- -------- -------------------------------------------- __------------------------ --- <br /> (Draw existing and required addition on reverse side) <br /> 1 .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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .....--- ----------------- - - ------------- ---------------- Owner <br /> ------------------------ <br /> lBy k -- ---------- - ------------ Title .... -_ <br /> - - -- - <br /> (If other}ha ow <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY R3u, -------------- - DATE ....-2-9--.7f- .-.. - <br /> �UILDING PERMIT ISSUED --. ---------------------- ------------ - ------------------------ - -------------DATE --------------------- ........:........... <br /> ADDITIONAL COMMENTS <br /> - 4 -------- <br /> 1 ..-_._�- <br /> ------77MP.VC-.----Q _t--- --------..._ ................................ . ..........._---••- --------- ---- ..._............- <br /> { - ----------------------------------- <br /> ------------------------------- <br /> ... - <br /> W - - ' <br /> ----- r <br /> ---------- <br /> ------­-------------------- ----- Dae----------------- ------------ <br /> .............. <br /> - Z - -Final Inspection by.. SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> v' <br /> E. H. 9 1-'68 Rev. 5M [,� <br />