Laserfiche WebLink
POR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> .•------------------•---•----.....,.._._...:._..._....._ Permit No. .._......-•--------•-.. <br /> 4, <br /> (Complete in Triplicate) . <br /> �. 3 <br /> 4 .-.g.. .......................•• Date issued _... �"7) <br /> ........................................................ This Permit Expires 1 Year From Date Issued w <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 Regulations <br /> JOB ADDRESS/LOCATION .. .................CENSUS TRACT _......................... <br /> 11 <br /> Owner's Nome ...A.,.gwe .. -o .............. _..---•_.__ ............................... -._.... ---••--.... ........................ <br /> Address ......w--••-a••....,1]C�/Sl�letere .................... City _� ....._ ...................... <br /> Contractor's Name .-----�.s_�..../-'�� �_�dZ------..----------- <br /> :., License # .7 . Phone . ✓Y _1G .:... <br /> Installation will serve: Residence fWApartment Houser Commercial. ;]Trailer Court <br /> Motel (]Other --"_--------... .. --- . ° <br /> Number of living units:___..... Number of bedrooms .—"'5----..Garbage Grinder_ ___--------- Lot Size ..CQ_,l!/' __-.-.----•---- 4 <br /> i <br /> Water Supply: Public System and name ..... .e- : �---------------- ---------1=-------...---------- ........................Private ❑ <br /> Character of soil too depth of 3 feet: Sand'Q Silt O Clay ❑ Peat❑ Sandy Loam w Clay Loam <br /> Hardpan [] Adobe 0 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 /> PACKAGE TREATMENT E ] SEPTIC TANK I ) Size--------------.................................. Liquid Depth ---------__....•.......... <br /> Capacity -------------------- Type -------------------- Materia€---------------------- No. Compartments -----...-...---...----.j <br /> Distance to nearest: Well ------------------------------------Foundation ---------- ........... Prop. Line ........... .......... <br /> LEACHING LINE [ ] No. of Lines ......­---------------­ Length of each line------_--------__--_--- Total Length ............................ <br /> 'D Box ------------ Type Filter-Material .:^....... ..........Dept h filter Material .......................... .•-_ --+ ...... <br /> Distanc0�t neares#: Well ..............`.. Foundation ---.....---_-.z::�.. Property Line <br /> , <br /> SEEPAGE PIT<-( j Depth <br /> ...............;,;t_ Dame#er Number .- >. --- Rock Filled Yes No <br /> I �❑ <br /> _ X <br /> Water Table Depth ---.....--- •-----------_--------_-_ ......Rock Size :........... k <br /> # Distance to nearest: Well _--------•----------------- ------foundation -------___ ....... Prop... Line ...................... <br /> I <br /> REPAIR/ADDITION]Prey. Sanitation:Permit#.........._.........------------------------Date- ....... <br /> SepticTank (Sfeclfy Requirements) .........................•---- ---•---••-•---......._.._..-----•------.._._....--•--....,....._.__.__�___-.........--•-------......:....-- <br />'.r Disposal field' (Specify Requirements) ----- r�.7�_�•-....:1� .P----- .1� .1'� 0� <br /> i ; , <br /> --•----------------=------------------------- -----•---------------'-------------------•-------------'- ------------ ,°..:---------- <br /> (Draw existing and required additiori on reverse side) <br /> l hereby certify that 1 have.prepared this application and that the work_will-be_done F'in accordance with San Joaquin <br /> E County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local'-Health District. Home owner or Iicon- <br /> sed agents signature certifier,the following- <br /> "I certify that in the performance of the work for which this permit Is lssued, 1 shall not employ any peri on in such mariner <br /> as to become subjecZ;_ <br /> rkm ' Compensation laws of California." f <br /> 'Signed --••-a.c _ ;- caner <br /> kBy .................... ................................._"-_ ---------------•- .................. .Title.--= .. ------ -••--•----------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLYkt <br /> � <br /> APPLICATION ACCEPTED BY .........DATE .-.- �------- ------ <br /> BUILDING PERMIT ISSUED -- ----•---- ------------------------------ ---------------------- -_-- -DATE _._ --_-----------------------•--•-•-- <br /> ADDITIONALCOMMENTS -------•-------••------•--------------•-- ......................_.._--..-------------•-------___.......... ---------------•-------------•---- <br /> -----------------------•------- _­----------•---•-------- --- --•-- <br /> --- -.--- .. <br /> -- . ------- ._.......................-,�•----..._..- . <br /> -.. _.........--- •... ---------•---------------- <br /> -------•----•----• - <br /> Final Inspection by: _.. ----------.-_-Date .... <br /> Eft 13 2!t 1-68 v. 5i SAN JOAQUIN LOCAL HEALTH DISTRICT 8/72 3M <br />