Laserfiche WebLink
FOR OFFICE USE: <br /> ,q APPLICATION FOR SANITATION PERMIT �� <br /> 1�,j� {Complete in Triplicate} <br /> Permit No. _- -_-___ f _ <br /> J This Permit Expires 1 Year From Date Issued Date Essued -a <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 'Made in compliance with County Ordinance No. 549 and existing Rules and <br /> - <br /> Regulations- <br /> 3 <br /> 3 =--CENSUS TRACT -------------JOB ADDRESS/LOCATION 0 ------ -------- ------------------------------------------Phone _1/4 '_.?7:4 <br /> ----- <br /> Owner's Name <br /> Address --------------- tGt <br /> y q � License # _ Phone - _ 'i <br /> y--- <br /> Contractor's Name ------------ - <br /> ey �. <br /> Installation will serve- Residence EJ Apartment House I] Commerc al ROTrdiler Court ;❑ <br /> f Motel ❑Other --------- - - P �� ' s <br /> / } � , <br /> Number of living units:-.--/..... Number of bedrooms __ _____.-..Garbage Grander ---- ----------------------------- <br /> Number Lot Size ___________ __ _______t__________...___ <br /> 1 <br /> Water Supply: Public System and name ----------------I_______________ ____. ------ _ Private E]Character of soil to a depth of 3 feet: Sand❑ Silt❑ 1Cfay ❑ Peat"(] Sandy Loam -E] Clay Loam,Q <br /> Hardpan E] Adobe Fill Material ----- ------ If yes, type ---------------------------- <br /> r , <br /> (Plot plan, showing size of lot, location of systWinilrelation fa w"�,l,ls•, build 14 gs, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit peAft"ted if public sewer is available within 200 feet,) O <br /> PACKAGE TREATMENT [ ] SEPTIC TANK l _fSize----------------------------------- ------ Liquid Depth ------------ -------------- W <br /> Capacity ----- - -- -- TYPe ------177777A-- Material---------------------- No. Compartments ------ W <br /> Distance to nearest. Well -------I--------- ------------------Foundation ------- ------___---�.Prop. Line _------------- <br /> ------- <br /> LEACHING LINE [ ] No. of Lines ----------------- ------ Length of each line----------------------------Total Lenad t_----- -�----- <br /> 'D' Box -; --------- Type Filter Material _ -_--____---Depth Filter Mat vial ------------------------- ----- i <br /> Distance :to nearest. Well <br /> "--__I__________ Foundation ------------------ -- Property Line -----__-------------- <br /> . <br /> SEEPAGE PIT { ] Depth -- !--------------- Diameter _----- ----- ----------- 3____ 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 ----------------------------------1 % . <br /> Septic Tank (Specify Requirements) m <br /> Disposal Field (Specify Requirements) ----------- aQ <br /> ------------ <br /> s <br /> -------------------------------------- ---------------- --------------------------- - X <br /> -- ------------- - ------------ <br /> -------- ---- -- --- - - - ------------- ------ - - - - - ------ ---- - <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 iniaccordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Rome owner or licen- <br /> sed agents signature certifies the fallowing: t <br /> "I 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 - ------- --- ----------- - ------------- Owner �- <br /> - --- -- �-- - ---- --- --------- ------- ----- Title - -- <br /> f of than owner) } <br /> FOR-DEPARTMENT--LSE-ONLY <br /> APPLICATION ACCEPTED BY -------`------=--------- r--------------. DATE y------------- <br /> BUILDING PERMIT ISSUED ' - J = = _ -_*_._ .'--- -NX---------�------------DATE ------------------------------------------- <br /> ADDITIONALA�Jk_­_ <br /> MENTS ----------- 1 F. v. � <br /> ------------------------------------------------ -------- -•-----------••- <br /> �i <br /> E --------------------- ------' �+-- - -------- - -- <br /> ------------------------------ -- ----------------•----- ---- --------------- <br /> - <br /> ----------- <br /> ----- <br /> ------ ---------- -- --------- ----------------- --- <br /> Inspection b - -------------------------------Date ----- ---------- <br /> Final _ f <br /> P y= <br /> N JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 0 �1-'68'Rev. 5M• <br />