Laserfiche WebLink
FOR OFFICE USE- <br /> APPLICATION FOR SANITATION PERMIT <br /> !Complete in Triplicate! <br /> Date Issued "sem 2-g'Z <br /> -...... <br /> This Permit Expires 1 Year From Date Issued <br /> ....... ............... <br /> I <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> rdinance No. 549 and existing Rules and Regulations: <br /> s described. This application is made in compliance with County , <br /> .....CENSUS TRACY .......................... <br /> JOB ADDRESS/LOCATIo .��•�i�'.. �.... � �. . ...... .. . <br /> ---- .tJLa[�t-t�_ ."............. .. .............. .Phonef. <br /> Owner's Name 1 i"1-'1--• .................."......,.. - <br /> Qerlc ,('i_�'........................City .... L'P.. .y.. <i..f`..T ---.... .................... <br /> Address :............ �a� ..�� l"...-`...l.._ <br /> Contractors Name - <br /> i'1.i.'I'4h.- ......License L? _. <br /> Phone <br /> Installation will serve: Residence®Apartment House Commercial❑Trailer Court ❑. <br /> Motel ❑Other .......................... <br /> Lot Size <br /> - Garbage Grinder "'"••,.. <br /> Number of Irvin units•-.._�....... Number of bedrooms -•••-•••••-• "'•' <br /> Private <br /> Water Supply: Public System and name . ❑ <br /> ....:.................................... <br /> Character of soil to a depth of 3 feet: Sand tj Slit C3 Clay ❑ Peat❑ Sandy Loam ❑. Clay Loam ❑ <br /> Hardpan 0 Adobe f Fill Material ............if yes,type ..... ......... ......... <br /> } - - ^` buildings, etc. must be placed on reverse side.) <br /> (Plot plan, showing size of lot, location of system in relation to wells, <br /> NEW INSTALLATION: (No septic tank or seepage pit .permitted if public sewer is available within 200 feet,) <br /> ' ...... Liquid Depth 0.4...... <br /> l <br /> PACKAGE TREATMENT .[ ] SEPTIC'TANK I ) . 5ize_...�:_11...�. .���•-•----•..-... q •--- .'...-- <br /> �i <br /> Capacity -Q YYPe � Material.. txti -- No. Compartments . ........... . <br /> M <br /> 1 ..... Prop. Line?. S <br /> k ` Foundation �.....__. -........... <br /> Distance;to nearest. Well - -••----......•• <br /> .. Length of ach line.-__-.R .... Yotal Length ... •--•• - <br /> LEACHING LINE [ ) No. of Lines .••••--... fj <br /> .: •�•� p <br /> 'D' Box'( �• •--.. Type Filter Material _16 R-?Y�Depth Filter Material �.?........--•...".. ......_ <br /> } <br /> DistanceItonearest: Well _._. _D_. <br /> Foundation .......... ........... Property Line -•• ............. <br /> SEEPAGE PIT { j Depth a. ........... Diameter ~�13-------. Number ..... Rock Rock Filled. Yes No (:1 <br /> ( ----• • •-•--•..Rock Size ..... . k <br /> Water Table Dep <br /> fh -•-----------••� <br /> � ..Foundation . <br /> "-" Prop. Line 6..-__..... <br /> • <br /> Distance to nearest- Wet! .................... <br /> .: Date C <br /> REPAIR/ADDITION lPrev. Sanitation Permit - <br /> ' ........................ <br /> .. <br /> Septic Tank l5(Specify Requirements) .••___. ....__..--•- <br /> I <br /> Disposal Field (Specify Requirements) ----_------ <br /> '----`-.. <br /> --••-------••--"•-......--- -•-------- ---------••-•...................,-------•• -----.__-......... <br /> ... <br /> :1 <br /> ------------------------------------------------- ------------------ --------------------------•---------- _ ...................................... <br /> (Draw existing and required addition onreverse�side)�- rT <br /> f I hereby certify that vI have pr4pared this application and that the work will :be done in.accordance with San .loaquln <br /> County Ordinances, State Laws;1and Rules and 'Regulations of the San Joaci6ln Local Health:District. Home owner or licen- <br /> zed agents signature certifies the following: arson in such manner <br /> "t certify that in the performance of the work for which this permit is issued. I shall: not employ any p <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed , -- - -- ---- ---•--- --•-- = Owner <br /> a <br /> ------ ;Title ------- <br /> ---- <br /> By— <br /> (1f.other tho ownerl <br /> PO DIP TME USE ONLY <br /> APPLICATION ACCEPTED BY ........ ...... --- --------------- -- �•C.. ..... -.:.:-::....DATE __ - P.. ... - ... <br /> L.- <br /> BUILDING PERMIT ISSUED --•--------------------- - ••- -...•--------............................... - ---.DAVE ..-------................................. <br /> . <br /> ADDITIONAL COMMENTS ------- `•----- ----••------------••-------- <br /> ..-•-- ..... ---------------•--- ----- .---• --------...-..------------------ ---------------- --------------....-...-.-------------------•------------. --- -..--------•------ <br /> ----------------------- ---..-----------•.. ';' .------•......-.-............-.--------- _Date ? -•-.-- <br /> Final Inspection I, .. <br /> EH 13 24 1-68 Rev. 5i B I SAN JOAQUIN LOCAL HEALTH DISTRICT /74 3M <br /> i <br />