Laserfiche WebLink
FOft`OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> .................................... <br /> Permit No. <br />......._.. .....I... (Gotnplete In Triplicate) <br /> .... ............................................ - <br /> Dab issued .. .. <br /> This Permit Expires R Year From Dale Issued <br /> App_cats . ........rebs q t District <br /> for <br /> a No. it t and existing Rules and Regulations:e <br /> Application is hereby made to the San Joaquin focal Health District fora permit to construct and install the work herein <br /> with County ...---..........-......... <br /> /� - ��. - " gam, >. ...CENSUS TRACT <br /> described. This application is made�ln compliance......_.�........:....�"d .: ...:.--- •� . <br /> JOB AQDltESS/LOCATI Z l- H <br /> r `` ....Phone . .... .... <br /> Owner's Name •----.... .:P ...----� •----\ ............. ........' � �...... ....��... I <br /> F�ddress .... ........... ....... .. r ICQ.._......_..City .... <br /> : • .: ..:... _......_......License .;f� _. Phone f . �f ;� ... <br /> Contractor's Name ... = : �,� <br /> Installation will serves Residence p Aporlmoe t House[] Com ertial pTrailer Court t I� a l$3 <br /> Motel ❑Other ........ - <br /> Number of',living-unit$•...:. Number of-bedroom% ._..Garbage Grinder ............ Lot S 2 ............................................ <br /> . . ------ <br /> mPrivate <br /> Water Supply: Public System and nae . .. .__ <br /> -.. -----•-• __..._..._........:.:.. ......._._....----•-:..- --...,............. <br /> Character of soil to a depth of 3 feet: Sand 1:] Silt❑ . Clay 0 Peat❑ Sandy Loam ❑�J .\Cloy,Loam D <br /> `Hardpan Q Adobe 0 Fill Material .............If yes,type ............... ............ � 1 <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be place&- on. reverse side. <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,�� <br /> . Liquid Depth <br /> PACKAGE TREATMENT ( ] SEPTIC TANK{ ............ <br /> ................ p :.: <br /> Size..........:. <br /> - - - ��, ..... Material... ... No. Compartments.�_�:� ----- TYpe •-��='.. _ d ... <br /> s <br /> /20 ..............Foundation Prop. Line ...:_:�........_.. .. <br /> • Distance to nearest- Well •~_•••• • f;-••-'- t <br /> BEACHING LINE, Na. of Line: �r�''.._._..... length ofA�tY. ... <br /> ane... �•-•••• .. Total Length ® ,.... <br /> R �'D' ox .. 1 .....• Type Filter Material .. Deptfi Filter Materia! ..��'..`d .. ........... <br /> . <br /> "�Weli" Property-Line-- ::-. ° '` <br /> Distance t4 iiearett: <br /> S Diameter e`.... Number ' .. Rock Filled Yes <br /> SEEPAGE PIT .5; Depth .. _.... .....................f j... <br /> s ....r..... Rock Slid. a� .. .. `.......... No <br /> Water Table .Depth ............................................. <br /> P.................... ,,Prop. Line _' DistanceFot01eOrest: h <br /> REPAIR ADDITION Sanitation Par Y <br /> (Prev.{ mit� ...................... Data}.... I <br /> / <br /> - -'.•-............. � ,... <br /> ......._.........., <br /> Septic Tank (Specify eqairsmenti9 •-• ............ ............................... <br /> _.. . .�. <br /> .i,. <br /> , <br /> Disposal Fietci (Specify Requirements ............... ....... ...........- :; <br /> ---------- ------•-- ............. •---- .......... <br /> . \ <br /> (Draw existing and required addition on reverse side) <br /> a 1 hereby certify that I have prepared this application and that the work will be dens In accordance with San Joaquin A <br /> County Ordinances, Stats Laws, and Rules and Regulations of.tits fan Joaquin Local Health Dishict. Home owner or licen- <br /> sed agents signature certifies the follawing: erson In such manner <br /> "t certify that in the performance of the work for which this permit is issued, 1 shall not employ any p <br /> as to become subject to Workman's Compensation laws of Califarnta." <br /> S <br /> .gnec� ----...... Owner -^ <br /> .........................:............... <br /> BY ....... . •---- <br /> S-..... Tills ........' ... �.. •. <br /> (If oth t an owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .....�.... ........... .. ...... ... . •` e: :,... ................_......... ........ <br /> d7JJ DATE l{j r .....�� ........ <br /> _... ;_. ,(( DATE=.:...- <br /> BUILDING PERMIT ISSUED .........:r......... 4 ..,......................................... <br /> ADDITIONAL COMMENTS .... t <br /> 1 ........:............. ... ..................... <br /> r - .... .................. -.........._.-........--....... .............. <br /> ------------- <br /> .... -...... . ......... .. —"�.. �....-.......... ..-.-.........Date <br /> Final Inspection by- ----------------- - <br /> EH i 3 2a 1-68 Rov. 5M � SAN JOAQUIN OCAL HEALTH DISTRICT / 8�7 <br />