Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------------- --------- ------------ Permit No. --------------------- <br /> (Complete in Triplicate) <br /> ------------ -------�­-------- -------__.!t--------- . I <br /> 41 . Date Issued ....I-----------_---- <br /> I------------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby mibde to the San 'Joaquin Local Health District for.a permit to construct and install' the work hereih <br /> described. This application ..is made-in compliancewithCounty'Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/1_0§71 –----- k–el-------------------- ------CENSUS TRACT p <br /> Y. ---- <br /> ------------------ <br /> ------------ -------7----------- --------------------- --------------------------- <br /> - <br /> Owner's Name - ----- --- ----- ----------------I----------: IPhone ----- <br /> Address f — - - <br /> -- City - - -- ----------- - --- - <br /> Contractor's ---------License <br /> ----- <br /> ------------- ------------ <br /> Name ----- ----------------- .......:�--------------------------------:-----------License # ------------------------- Phone ------------------ --- <br /> .,Installation will serve, Residence ❑ Apartment House-E] Commercial[]Trailer Court <br /> Motel F1 Other ---------------------------------------------- <br /> ------------------- <br /> Number of living units_____________ Number of bedrooms ------------:Garbage Grinder-' Lot Size ------- -------- <br /> 'Water Supply: Public System and name -------------------------------------------------------------- ---------------------- --------------------------PrivateX <br /> Character of soil to a depth of 3 feet. Sand E] Silt F] qlay'F] Peat I E] Sandy Loam Clay Loam ❑ <br /> Adobe E] 'Fillj�A6teridl--------- --- If yes type ---------- ---------- - <br /> Hardpan -- ----- <br /> (Plot;'plan, showing size of lot, location of system in relation tb'.'.wells, buildings, etc. must. be placed, off' reverse side.) <br /> e �.6blic seweris,available within 200 <br /> NEW INSTALLATION: (NP septic tank or seepage pit p �miti' A-je feet,) <br /> PACKAGE TREATMENT SEPTIC TANK'[ ------ ----------------------:_Aiquid Depth ---------------------- <br /> Capacity -------------------- Type ---------------------- <br /> dlrrtefial --------------------- N16: 'Co"mpartments -------------_------- <br /> Distance to nearest: Well __!------------- <br /> n <br /> ------ -------�__Fou clation ----------------------�Prop. Line ----------------_-- <br /> LEACHING FINE No. of Lines ------------------------ Length of each line------ ---------- Total Length -----------�L:------------ <br /> 'D' Rox ------------ Type�Filter Material. ------------DepW Filter Matericil`___,__.�--------------------- -------------- <br /> Distance to nearest: Well ---------------- Fbu6dation ---------- ------------ Property Line- ----- ---------------- <br /> - <br /> SEEPAGE PIT Depth -------------------- Diameter ------------- Numbe-- --------------_s___-________ Rock Filled Yes 0 No C3 <br /> --------------------- -- ------- <br /> Water Table Depth - <br /> ----- ----- -_Rock Size ------------------------- <br /> Distance to nearest: Well --------------------- - ---------0oUnclatipri ......... --- i <br /> Prop.,Line --------- <br /> REPAIR ADDITION rev. Sanitation Permit# ------- ----------- ------------?t----- Date ------------------------------ <br /> i ecp e ci -------- <br /> Septic pecify Requirements) --------------- ---------------- ---------t - ----- --------- <br /> --- <br /> Gil <br /> Disposal. Field (Specify Requirements) ---- ------- Z-1 <br /> ---------------------------------------------- --------- -------- ------------------- --- ----- ---------------- -------- -------- <br /> --------------------- -- -----------I----------------- <br /> - ------------------------ �F--------------------------------------------------- -------------iir <br /> (DrZiw exis n on re <br /> t i n g Ini'd, additio va-se,side) <br /> * <br /> I hereby certify 'that 1.have prepared this application and that the w*1k1',rwiIr bedone in, a icco' rdan1e with San ,. <br /> ' Joaquin <br /> County Ordinances, Stifle Laws, and Rules and Regulations of the San".-Joaquin Local-Health D.istricf. Home owner or licen- <br /> sed agents.signature certifies the foil owing: <br /> "I certify that in'the performance of the work for which permWis isst;64,'it'shalitinat empidy any'person in such manner <br /> as to-be6me subject to Workman's Compensation laws lifornic." <br /> N <br /> ............:3ign - --- ------------- r <br /> - ------------------------------ -- ----- Owner <br /> -- - - ------ <br /> - ------- ------ ------- -- - <br /> { <br /> -A <br /> (If other than owner) <br /> FOR DEPARTMENT USE ON <br /> APPLICATION ACCEPTED BY <br /> -: - - - f - -------------I--- 6.ATE <br /> ----- .. <br /> BUILJING PERMITISSUED ----- - ....... --- -- .. ----------- <br /> ---------- <br /> --------�TE ---------- ---------------------:------ <br /> ADDITIONKC COMMENTS <br /> ------ -------------_-- <br /> -A--------- <br /> --------- --------------------- --------------------------- ---------------- ------ --------- ---- ----------- --------------- <br /> ----- ----- <br /> ----------- ----------- <br /> __x N_ ----------------------------------- <br /> ---- -------------------I- <br /> ---------------- ---- -- -----------W-------------------------------L <br /> ------------------------------------ ------------------- -------------------------------------------------- -------------- ------- <br /> Final Inspection by4L ---- Date --------- <br /> -- ---: ---- --------------------- - ------------------------------------------------------------- ........ ---------------- <br /> 75 <br /> -SAN JOAQUIN 'LOCAL HEALTH, DISTRICT Oft, <br /> E. H. 9 V '68,.Rev. 5M <br />