Laserfiche WebLink
FOR OFFICE USE: - R FOR OFFICE USt: <br /> APPLICATION FOR SANITATION PERMIT <br /> .................................. Permit No...7 - <br /> (Complete in Triplicate) <br /> ---•------ ----------- - ---- -- --Z------------ <br /> Date Issued. '. y. .9 <br /> _ _ This Permit Expires 1 Year from Date"Issued <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION... ------ ---------------- .-..CENSUS TRACT... _.. <br /> Owner's Name..... ... Phone <br /> -- <br /> Address---------------.. 1 ..::........ -- . ..................... .i ... City..........---•---- Zip._;..... .......... <br /> Contractor's Name---- ................................................ ---License #........ <br /> Phone <br /> Installation will serve: Residence Apartment House E] Commercial [ITrailer Court ❑ <br /> Motel 0 Other- .---------• <br /> Number of living units:... ------------Number,of bedrooms............Garbage Grinder------------Lot.-Size--------...----------.............r._- =------------ - <br /> Water Supply: Public System and name-....... --------_------- ------------------------------------------------ -------- Private E] <br /> Character of soil to a depth of 3 feet:," Sand Silt❑ Clay ❑ Peat ❑ Sandy Loam 0 'Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material-. --_ ....If yes, type----------------_---.-.-. --.- <br /> Mot 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 [ ] SEPTIC.TANK [ ] Size---------------------------------------------------------------------------------- ---------:----Liquid Depth----°------------- <br /> -- -- <br /> Capacity.... -��-- ----,Type---------------- ------Material-----------•------------.:No. Compartments........:.-- _--------� <br /> Distance to nearest: Well----------------..................... Foundation-------.--.- .--- ......:.Prop. Line......-_....-.-.-.------� <br /> LEACHING LINE [ ] No. of Lines.............................Length of each line_---------------------------Total Length ....------,............................ <br /> - <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 (Prey. Sanitation Permit#---------- ------ Date--------:-------------------------------I------ <br /> Tank (Specify Requirements)...:.----- - --- - ------------------------- <br /> Disposal Field (Specify Requirements)- - .. ............... - <br /> - ........... <br /> ...... a .. <br /> 'UC.. - a�-... �,.-a`^ ------- .....----.•......--- ....... ---..... <br /> ( <br /> Draw existingand required addition on reverse side[ <br /> I hereby certify that 1 have prepared this application and that the work will be done in' accordance with -San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> 4 <br /> signature certifies the following: I _ ' <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 as <br /> to become [e r an's Compensation laws- of `California." <br /> Signed -- -'--...---- �---• �----------- - ----------------------------------- <br /> ---Owner "dV <br /> By..........•........ Title"---- ---­-------------------- - ----------------- <br /> (If other than owner) <br /> K 16 FOR DEPARTMENT USE.ONLY <br /> APPLICATION ACCEPTED BY-,- �C�...O�------------------- ........................ ....-DATE.....������1� - <br /> DIVISION OF LAND NUMBER. -----_-------------------- --------------------_ ---.....--- .._DATE... ---------- ----------.,----- - -------- <br /> ADDITIONAL COMMENTS_.............. .. <br /> - ---•---_---- ------ .- <br /> _......................-............------------------....--------------------------......... -- <br /> �y................... <br /> ......................................... ..............I-------- ..........---... --- ..----- - _...-. <br /> -- <br /> ....-._._.._-- -------------------------------- --------•------------...__.------- .. ....... ...... ....._ <br /> Final•InspeCikon b te-- ----- <br /> re 7 REV. 7/76 3M <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT._` X6 <br /> �,. <br />