Laserfiche WebLink
� <br /> FOR OFFICE USE: ,. <br /> APPLICATION FOR-SANITATION 'PERMIT - <br /> --------------- - ------------------------ - r....,Zmr. _ —"—Perm <br /> (Complete in Triplicate) it-No:"- --_.-(O�S <br /> ----------------------_.-------___,__-----____---------- r This Permit Expires 1 Year From Date Issued <br /> Date Issued ��:_ _-71 <br /> Application is hereby!made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> l described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION ------ ------------------- - .-CENSUS TRACT <br /> Owner's Name ' <br /> -----------------.---------- y��----- . r Phone _y - , <br /> AddressyL !"�- �- -- ----------------- City -.�Ct /1'd� ---------+----. <br /> Contractor's Name - `�� ----------------------------License # -,PM:7!4'9_ Phone ------a�--•'--"----- <br /> -lnstollotion will serve Resid nce� Apartment House Commercial : Trailer Court <br /> `Motel [❑Other -------------------------------------------- y�y y��' <br /> Numljer of living units..---/----- Nurri.ber of bedr o s -----/-.-.Garbage Grinder ....e4)__ Lot Size ___p�i-a_-__�--_-`_�_'.__..---_ <br /> ', 'f �',.. - ------- <br /> Water.Supply: Public'System and name�__ - Private ❑ 4 <br /> Character of soil to a depth of 3 feet:* Sand' SiltClay -Peat❑ Sandy Loam Cloy��L� <br /> ❑❑ E] ❑ oam ❑ 1 <br /> HA pi ardpan ❑ Adobe Fill Material ------------ If yes,type ---___-_.-------'_______-_ <br /> r (Plot,plan, showing size of lot,!l.ocation of system in relation to wells, buildings, etc. must be placed on reverse side.} \ <br /> NEW,INSTALLATION-I (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> , <br /> PACKAGE TREATMENT [ 'SEPTIC TANK [ ] Size---------------------------- ------ ------- Liquid Depth -------------------------- <br /> a <br /> Capacity p Y --------------------- Type -------------------- Material---------------------- No. Compartments <br /> I t f `"No.%of Li1 <br /> LEACHING LINE :to nearest: Well ____________________________________Foundation --.-.------_ _ .. <br /> __- --__ Prop. Line __.. _-_----__;_ <br /> = i )Q nes --------I------------ Length of each line---------- D---- Total Length ---------- --------- <br /> D' Boz _J_/_____ Type Filter Material _� -__.Depth Filter Material -----__.�-9Y�------------------------ <br /> f a t mss..,.w..�,..r. <br /> ! Distance to nearest: Well ----- �r. -„ ,,,-, 3ttj`„.�, <br /> -- -------��- Foundation f- -----14)--------- Property Line, ---------6._........... <br /> SEEPAGE PIT , Depth, --� Diameter _ _T, ------ Number ___Numb __----_-.--__-_------ Rock Filled Yes No ❑ <br /> i y i S , ii <br /> I Water Table Depth --------------FQ_.--------------------------Rock Size ---------------------•------------ <br /> oo” I i I I <br /> Distance to nearest: Well -____----eC___---------------------Foundation ------ Prop. Line --------�~...__.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------I------ --------------- Datet__--_--_----_--_.---------------- <br /> } <br /> I 1 +� <br /> Septic Tank (Specify Requirements) -------------------------------+ --__,:---- --t ------------------ --------------------------­ <br /> fSpeciN'Field {Specify' Requirements) / � �' -------'�� '�1--� -,-P' <br /> ==---------- - g _ <br /> g q <br /> ----e:_ } ---)Draw existing----------------------------------------------- <br /> and required '------------------------------------------------------ ----------- --------- <br /> fj i� ( „ '( , addition on reverse side) <br /> w I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin <br /> County'Ordinances; Stc(te,�aws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the folio_wing: { <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 Compensati.an laws of California." <br /> ( <br /> Signed -------------------- - Owner <br /> Y "`' IE-�Q -------------------------------------------- -Title ..--1 --/ 2 <br /> (If other than owner) <br /> 1 " 1 1 <br /> FOR DEPARTMENT USE ONLY a <br /> APPLICATION ACCEPTED, BY --------I------ --------------------------------------------------------- DATE --- <br /> BUILDING PERMIT ISSUED .�__ 1 ._1 DATE <br /> ADDITIONAL COMMENTS _- �j -• .--- ------- -- - <br /> r <br /> ----- <br /> ------------------------------------------- -------------------- ------------------- <br /> ---------------------- <br /> - f-------- <br /> --------- - ---- ------ _ __ <br /> -------------- --- --- <br /> Final Inspection by: � _- l ' f =_ L-------------- = :_,Date-- L, <br /> JOAQUIN''.LOCAL"HEALTH 'D.IST1t1C7 .-_, .- . W,,_ <br /> E. H. 9 1-'68 Rev. 5M <br />