Laserfiche WebLink
FO:1 OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT G <br /> (Complete in Triplicate) Permit No.6 Z.-6.q? <br /> .......... This Permit Expires I Year Fram Date Issued Date <br /> Applicatio,. 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 Coou+t Ordinance No. 549 and existing Rules and Regulations: <br /> 9 d c'� Yt. GU c>'V✓.�2� <br /> JOB ADDRESS/LOCATION (,(JU..cl_b/ /ca'r 1 . - � A.I. <br /> f........ 2 ;i ... ...... ...CENSUS TRACT ... <br /> Owner's Name <br /> y ............................................................... <br /> Address �:r.��• L. v- - Phone ................................... <br /> �. ...D..............._..................................City ../�.Cf'�%.Y✓. <br /> Contractor's Nome _ 1 �� <br /> `:.... -C c �..�::.._� :................................License# i <br /> jInstallation will serve. Residence Apartment House <br /> j Commercial❑Trailer Court [] <br /> Motel❑Other...SC�J� i?.f�D•(✓•��C', — l�-OF>1r�!/Y fi �'�/�Ch7 <br /> Number of living units:......... .. Number of bedrooms ............Garbage Grinder ............ Lot Size ............................... <br /> Water Supply: Public System and name .................................... ...Private p <br /> Character of soil to a depth of 3 fee': Sand❑ Silt p Clay p Peat❑ Sandy Loam ❑ Clay Loom ❑ <br /> i <br /> Hardpan❑ Adobe ❑ Fill Material ............ If yes,type.......................... . <br /> , <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: !Ivo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENTSEPTIC TANK <br /> ( � ( ) Size... ..................... ............ Liquid Depth .......................... <br /> Capacity ...... ........... . Type .................... Material...................... No. Compartments <br /> Distance to nearest: Well ....................................Foundation ......... .... ....... Prop. Line...................... <br /> LEACHING LINE ( J No. of Lines . I. ... ..... . .... length of each line . ... .%U.2.......... Total Length .LIPP................ <br /> 'D' Box ..J:"._. Type Filter Material .AA ........Depth Filter Material ..../...,F-".............. ' <br /> Distonr_- to nearest: Well .... ................... Foundation ..... .................. Property Line ............ <br /> 1 SEEPAGE PIT Depth Diameter ................ Number ................ . ... ..... Rock Filled Yes ❑ No <br /> Water Table Depth . ......... .. ................................Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........ ......... ............. ........... Date ..................................) <br /> Septic Tank (Specify Requirements) .. ..... . ....._ _ ........................................ <br /> ........................................_.............._,.�../.............. <br /> Disposal Field (Specify Requirements) /f l.. ......../...15........./�1..........ulc,- 1,2....-L.fJ.i <br /> fa.i: .... t u.i;�S.h......r�o.Lv.,.Y......./, .`,....... <br /> (Dra exist' g and required addition on reverse side) <br /> I hereby certify that I hnve prepared this application anri that the work will be done in accordonre wtth San Joaquin <br /> County Ordinantes. State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sad agents signature certifies the fellow.ng: <br /> "1 certify that in the performance.-if the work for whic:: this permit is issued, I shall not employ any person in such :Wanner <br /> as to become subject to Woskman'�. Co-�ipensction laws of California." <br /> Signed <br /> . ... . ... . Ownrr <br /> B __ .. , ... . ... Title . . <br /> If other than owner) <br /> FOR DEPA'TMF.NT USE ONLY <br /> ADPLICA11ON ,ACCEPTED BY . DATE .�..:��' '( <br /> BUILDING PEkMl ISSUED . ...... . ... •. <br /> ADDITIONAL COMMENTS. ;; ............................. <br /> . ............................... .::.. ::�.:.......- .. .._ ..... ........�.'.�:: ti':�.... ......... ................ <br /> . .. ... .. .......... ... ...... .... . ... ...... . . . <br /> :l. <br /> Final Inspection by. . <br /> G . <br /> SAN JOAOUI I LOCAL HEALTH DISTRICT <br /> E.H. 9 1-'68 Rev. 5M <br />