Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT _ <br /> (Complete in Triplicate) Permit No./.2/n 3e,—� <br /> Date Issued /7 <br /> - . This Permit Expires 1 Year From Dat*Issued <br /> /4F" .7 <br /> -Application is hereby made to the San Joaquin Local Health District for a permit to co sttutt olSd" insttil�the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 an existing Rules and Regulations. <br /> )OB ADDRESS/LOCATION IOC_ IV ORIV41tl _ . CENSUS TRACT ... <br /> Owner's Name �� �/ �'�l1lJ`,e /�/ . .... .... .....Phone <br /> %ddress City <br /> Contractor's Name ._ lC/�fll�1. . ..�i�yi/G z... .... _.......... ----..-.License # .__. ...... . Phone /.Ll..2......... <br /> Installation will serve: Residence ® Apartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑Other <br /> Number of livingunits: Number of bedrooms <br /> -..- ......Garbage Grinder f.. ...... Lot Size G.......` .............. <br /> Nater Supply: Public System and name .. _-- - ........Private 0 <br /> _haracter of soil to a depth of 3 feet: Sand❑ 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,) <br /> 'ACKAGE TREATMENT f ) SEPTIC TANK �/�-t SJ <br /> ,') Size.. -•..... .. ......................... Liquid Depth . .�i/............. <br /> Capacity � '. _ _ Type -�..�' Material./- No.No. Compartments .;7.... <br /> i <br /> .......... <br /> Distance to nearest: Well le-'J --- -___---------Foundation /d..---------- --- Prop. line .S.V............ <br /> O <br /> cEACHING LINE FVJ No. of Lines .-J`.._...�.._ Length of qch line �.��..._. Total Length - . <br /> 'D' Box /�. Type Filter Mater ��_ .....Depth Filter Material . ./.�7....�..........-0............... O <br /> Distance o nearest: Well .. /.&-0...... Foundation /0.... ... . Property Line .-5............. ....... 1 <br /> SEEPAGE PIT Depth ...�.......... Diameter 4. Number /.. ----------- -- Rock Filled Yes_2' No C] <br /> Water Table Depth ..... /;�Q• .Rock Size .. '.� '................. <br /> Distance to nearest: Well .../S.b...........................Foundation .....l'0......... Prop. Line ... 6-._...._... <br /> °EPAIR/ADDITION (Prev. Sanitation Permit# --------_.................................. Date .------................. ) <br /> Septic Tank (Specify Requirements) ........... - . . ............._...... <br /> Disposal Field (Specify Requirements) _._. ............................_......... <br /> - - <br /> (Draw existing and required addition on reverse side) <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> �ounty 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 /> _s to become 'Meetto orkma�argpensation laws of California." <br /> Signed�y <br /> . ......_ .. . .. .... - - --- ----•---------- -- Owner ,(/�/ <br /> ... --- ....... Jitle vi`ijjj iii <br /> - (If other than owner) <br /> ... ... <br /> FOR DEPARTMENT USE ONLY <br /> ,PPLICATION ACCEPTED BYDATE <br /> BUILDING PERMIT ISSUED <br /> - _. <br /> ADDITIONAL COMMENTS <br /> Final Inspection by: .. _ Date ll <br /> 4 <br /> �7 <br />+11 13 211 1-68 acv. SAN JOAQUIN LOCAL HEALTH DISTRICT 3M <br />