Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT <br /> ................... <br /> I1 i �/ (Complete in Triplicate) Permit No. <br /> .......... <br /> This PennU Expires 1 Year From Date Issued Date Issued <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 is rmaddee in compliance with County Ordin nce No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ...V.Y.� ..... �P�Af� .---- ---------------------------------CENSUS TRACT ........................ <br /> ` Owner's Name �. Tf <br /> '/` off . Phone3. .... ` � .X `7Address ... - City .Contractor's Name sF-Uy�------------_-----License # ��.:�.��_ Phone _.wg::f44 l7-.• <br /> installation will serve: gesidence JXAportment House❑ Commercial❑Trailer Court Q <br /> Motel ❑Other-------Y� /..........-9---------------- <br /> Number of living units------- .._.. umber of bedrooms .-_-.. -Garba a Grinder ------------ Lot Size ...... .r4 t > T......._.__- <br /> Water Supply: Public System and name .................................. .... ......-:--. .--------- ............................_.......... Private (� <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat[ISandy Loam ❑ Clay Loam ❑ <br /> "i <br /> Hardpan ❑ Adobe/0 Fill Material ............ If yes,type ............... ............ <br /> (Plot plan, showing size`of Idt, 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 TREATMENT [ ] SEPTIC TANK( ] Size..........................._....__....._....._. Liquid Depth ----------.._---.___._-- <br /> Capaaty`....:- - ----- Type - Material. -- No. Compartments _ <br /> ----.._ <br /> Distance to nearest: Well ....................................Foundation Prop. Line ........_............ <br /> LEACHING- LINE 17 No of Lines . . .-.-_..:_ Length)of each line................. Total Length ................_._...... <br /> —r— D Bo ............ Type Filter Material ........ ..........Depth Filter Material ........._ .................\ <br /> 4Risto �otnearesty*ell ... r .... Foundation ....._.... _.__.. Property Line . .. ........... (,� <br /> SEEPAGE PIT [ I Depth .__........ ..... Diameter Number Rock Filled Yes ❑ No Q 1 <br /> Water Table D 13 - -.-- Rock-Size ..... .......................... <br /> Dista n e.tc n a est: Well .. -- .........FoundgtIon ..........-........ Prop. Line ........... .. .. ... <br /> REPAIR/ADDITION(Prev. Sanitation mit I..;-------- ----------------------_:--__---- Date ....'.._..:...................... <br /> j <br /> Septic Tank (Specify Requireme is) -_-... - ------------ •---_•----. <br /> Disposal Field (Specify RequAi is) ........Q . ........' r___ �L�f�______________ ____ __________ _ __ <br /> _ - <br /> - .N_x.a- '----- -- -- ------------------------- -------- _...._.....---•-••-•----- <br /> -- ----- ---- a. <br /> (Draw exi{ting and required addition on revefse side) <br /> I hereby certify that 1 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 Healfh.Dlstrid. 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 /> ey -- --- - - - ..............................---- Jitle ---- <br /> ------- - -- - - - _... <br /> --- --- --- - <br /> (I Cher n owner) <br /> F DEPARTMENT USE ONLY // <br /> APPLICATION ACCEPTED BY __Gd --l- ------- <br /> .- - .. DATE 2.72"T 75... <br /> BUILDING PERMIT ISSUED <br /> _ <br /> BUILDING -- ... -- DATE - - ..... ......... --------- <br /> ` ADDITIONAL COMMENTS ------ ------- - MM .... <br /> ... <br /> ............. .... . .... --------- ---------- - .... .....-..... _---------------­---- <br /> ----------------------------- --------------•------- ---- - - -• . ....... <br /> Final Inspection by: --------- ------------- ....-------- -- - --------- -------- '--- ."------------------....---Date .... �.�./-.�..<�. --- <br /> - <br /> Elf 13 24 1-68 Rev. 5m SAN JOAQUIN LOCAL HE LTH DISTRICT 8/71t 3M <br />