Laserfiche WebLink
00 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> - (Complete in Triplicate) Permit No.7..L.=3-1 -.. <br /> - ..... - - / 7a. <br /> This Permit Expires 1 Year.From Date Issued Date Issued . .-_._ice..... <br /> Application is hgreby made to,the San J _aquiq-Local-Heaith,District for a permit,.to construct and install the work heroin <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ` JOB ADDRESS/LOCATION _.S...r_..-&Q? w--�p-•�--/�-- , - -.d'---. ...-...--•--- 1 --CENSUS TRACT ....:S <br /> U <br /> Owner's Name �--t--+.�'� '-•---...'----------Phone -............................. -... <br /> Address -.......'- 3 Qp/ - <br /> oi__- -- `---•-- ..:----- -B�CIe-- -P'±:r�....-1.- ---..-..... City ... ------'- <br /> r Contractor's Name r. ![-..- ..... ----.License# -�8.�,. .cf.Y Phone -----............. <br /> Installation will serve-. ,Residence❑Apartment House❑ Comme�rcial: �T^railer Court '❑ <br /> Motel ❑Other ---... G <br /> Number of living units:--/.... Number. of bedrooms.tt. <br /> :_-.Garbage Grinder ..... Lot Size .._-............. .......... . <br /> Water Supply: Public System and name ........................................ .'-----------_----`-----•----_-......--- ....-.....-.._....--Private (� <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ U <br /> Hardpan y Adobe❑ Fill Material ------------ If yes,type .................. ......... W <br /> (Plot plon,.showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) c0 <br /> NEW INSTALLATIbNc (No septic tahk or seepage pit permitted i public sewer s available within 200 feet,) r <br /> [ ) SEPTIC TANK Size.___-, .-_... GG p <br /> PACKAGE TREATMENT ,,!!}} � �_.1_...�.............. Liquid Depth --.�'...___--..-...-.-.- y <br /> Capacity�.�. i.4.. TypeL.' .t ._ Material---f?L.'l�t,E`._ No. Compartments ..r.:--�.�,_..-._... <br /> 11111V11111 <br /> Distance to nearest: Well �.....sj�.�.......•._..-___Foundation ---/._9............. Prop. Line .-S-_.-"..,--.__ ' <br /> .� LEACHING LINE [J✓No. of Lines ....._.�..--..._..�. Length of•each Iine..__..-1 O�_...-. . Total Length _/..0._tf--........_. <br /> 'D' Box .r. Type Filter Material ......Depth Filter Material .............. y <br /> Distance to nearest: Well ............. Foundation ._...._. ....... Property Line ... ....--_..-...... s <br /> SEEPAGE PIT [-/ Depth .._�.�...-_ Diameter .,- -. . ` sa--_...._._. Rock Filled Yes Up No Q � I <br /> tf ----- Number -...--- <br /> ✓ f <br /> Water Table Depth ............gT.............................Rock Size_.1,//.T._.._-�..�...._-- <br /> Distance to�nearest: Well _..-...-.Ia?I?-�..................Foundation .-1- - ----.-.. Prop. Line .. _�........_ <br /> REPAIR/ADDITION(Prev. Sanitation IPermit#...................... ............. Data ................-.................I <br /> Septic Tank (Specify Requirements) .......--.........•--------------V.✓-----..--_ <br /> .. Disposal Field (Specify Requirernnents) ............. <br /> ._._..................---'-"-`-----...__.."-------------------- .......................'---•-..........-..-.-........................,.................... --..._......... _ f <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, Stare 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 subject to Workman's Compensation laws of California." <br /> Signed . I ------------------------------ Owner <br /> By ......--'--.................. - . ` . ................ Title ...Q-4 . <br /> _..... <br /> (if other than owner)I <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY=-I. -- - - — '---'--"----.............. . DATE_.- ..'. -:-.1. ---•------...... <br /> BUILDING PERMIT ISSUED....-......�.- _ j� DATE ........................_....-...--......_ <br /> ADDITIONAL COMMENTS--- �a " - ........ ........._ -..... ..._.-._.... ---.........--..... ............................. <br /> -------.... ............................... .....................� . --........................................- -.........-----•-••-•. .............................. ......-- <br /> .. --- ....."-•- - - - -' -----------'-------- ------ <br /> - •. <br /> Final Ina -i- - •-.. .......-- ....---..Daft---7�='L 'T2 ...... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1•'68 Rev. 5M <br />