Laserfiche WebLink
=. FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------------------------------------- - <br /> {Complete In Triplicate) mit No. _-..- <br /> ...............••--- DO .-......-.... <br /> !,t This} erntit Expires t Year From Date Issued Date Issued <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. 5.49 and existing Rules and Regulations: <br /> JOB ADDRESS/LO ATION ... �.... .... ... ....A-elk <br /> ................ ......... <br /> � � ACT .......................... <br /> Owner's Name hone . <br /> tl••-...... � - ... .................... <br /> Address . _ -dw"....� v� //•..... City .... ....... . .. .. ....­............ .............. <br /> ... <br /> Contractor's Name '' <br /> ��. - -•-• ...... ... ... .. License # f --- Phone ............... <br /> Installation will serve: Residence qApartment Houseo Commercial ❑Trailer Court 0 <br /> Motel ❑Other............................................ <br /> Number of living units:--------L.- Number of bedrooms ... .Garbage Grinder ............ Lot Size ....................................... ... <br /> Water Supply: Public System and name <br /> ... `-.... ......._.---=•--.....:--•................................ Private <br /> i ate <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat❑ Sandy Loam❑ Clay Loam ❑ <br /> Hardpan j] Adobe.0 Fill Material ............ if yes,type............... ............ NkN , <br /> (Piot pian, 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,) i <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] <br /> Size................................... -.. Liquid Depth .-----•--.... ........... i <br /> Capacity -•---------------- Type ---- ------ Material...................... .No. Compartments ..................... <br /> Distance to nearest: Well ---................................Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE [ ] No. of Lines ............_.;- -----• length of each Ilne............................ Total Length ........................... <br /> 'D' Box ------------ Type Filter Material .---------_-......Depth Filter Material ............................................ <br /> Distance to nearest: Well ........................ Foundation ......................... Property Line ........................ <br /> SEEPAGE PIT [ ] Depth ,----............... Diameter -------..___---- Number ..............................Rock Filled Yes ❑ No <br /> Water Table Depth .......: .......................................Rock Size ........ ....................... <br /> Distance to nearest: Well ........................................Foundation .............. Prop. Line ....................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------­---------------_--_- -_-------- Date .........................•-....... <br /> ]- � <br /> Septic Tank (Specify Requirements) ------------------- == ------- ---------------- ..................-..................................... <br /> ..- <br /> Dis osal Field (Specify Requirements} ---� <br /> ------- <br /> -. <br /> ............. <br /> Lvo <br /> ---•-�--r'-----.. .. _ - - -- --,I 'r!. •_--. - _-.- ---------------------------------------................... ._. <br /> (Draw existing and r quired addition on reverse side) f. <br /> f hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.District. Home owner or licen- <br /> sed agents signature certifies the following: <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 I <br /> cis to become subject to,Workman's Compensation laws of California." <br /> Signed ---- -------- Owner <br /> ---- <br /> BY �� .. r.- . Title -. . ----------------------------------- <br /> (ifI <br /> ' other than o ner) . <br /> FOR DEPARTMENT USE ONLY I <br /> APPLICATION ACCEPTED BY ...... ....... <br /> DATE ....,�� .. .......... <br /> BUILDING PERMIT ISSUE© -..- --------------------- <br /> .. ............... ..... .........: DATE . ----------------------- i <br /> ADDITIONAL COMMENTS � ��---....1��t`4 - _...f�° - ..... <br /> -------- -------------------------------------- -------------- <br /> ----------- ----------------- -------- -------------• -------• •-- --------..................... ... ----..--...------............ <br /> ... - <br /> ------------------- --------..-..- / tl <br /> Final Inspection by: '. '.............. = Date_.. ./..7/.7s ....----.:-.- .. <br /> EH 13 2L 1=65 lay. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74" <br /> 74 3M <br />