Laserfiche WebLink
FOR OFFICE USE: �� y <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------------------------- <br /> �8 /n --� <br />€ � (Complete in Triplicate) 1 <br /> Permit No- ----------- -!f_. <br /> Date Issued 6.2 <br />` <br /> ------------------ -------------__---------------------- This Permit Expires 1,Year From Date Issued <br /> -y <br /> Application is hereby made to the San Joaquin Local HealTh1 District for a permit 1to 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 /> CENSUS TRACT _____ __ <br /> JOB ADDRESS/LO`C�'TION /ai_/_�f -��r--- ------------------------: - �y <br /> YPr1✓©I✓.--- — r`' r-------==--------------------- --------------------------- <br /> --------------- <br /> -------- Phone A� 3-- _ . <br /> Owner's Name __ __ <br /> �/ - City M_ /]� � - <br /> Address �6 f1 <br /> Contractor's Name _r - , ---------------License # Phone ¢_3fn6S_2 _X <br /> Installation will serve: Residence ❑ ApartrNent House❑ Commercial [-]Trailer Court ;❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units_____________ Number of bedrooms _,______Garbage Grinder/VV------ Loot Size ______________ <br /> - - _-­ <br /> Water.Supply:�P-ublic-System=and°-name=fir"--- ----------=- -"--=-=_�---------------- ----=--------------`Private i► <br /> Character of soil to a depth of 3 feet: Sand'[K Silt Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe ❑ 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 [ SEPTIC TANK.N S=aterial <br /> _ ?�__s,?f/__v__.______ Liquid Depth _ ______________ <br /> Capacity {_l_ d_[)_ Type /y 11 p <br /> -_ ___a5r14._4' .' Uom arfments __f�-� ...._...___ �l <br /> istance ,to nearest: Well ___(57-6_r__________________Foundation` ____________ Prop. Line _____5 �___._.___ <br /> ---._ Total Length ---�_a-6-.._. --. -•- <br /> LEACHING LINE No. of Lines ____.�______________ Length of each line______.�d__._ _ g <br /> . « <br /> _:`° 'D' Box _ ;;77 <br /> �; __ Type Filter Materi� KQ__________Depth Filter Material __l�_ ____________________�___..,... <br /> Distant to nearest: Well --___lam- --------- Foundation __________ Property Line -----Cg�-____:__:____ <br /> SEEPAGE PIT Depth ___ Number __.____________ Rock Filled Yes � No <br /> O p -------------------- Diameter` ------------- © iCl <br /> Water Table Depth --------------------------------------------------Rock Size --------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------------••-.----- <br /> 1 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________j <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) --------------------------------------------------- --------- -----------------------------=----------------------- ------------------ <br /> --- <br /> ----------------- <br /> ---- ---------------------------------------- - ------ <br /> -------------------- <br /> - - - - --- - -- - ----- -------------- -----'---- -------------- ------------------------------- ----------- ---- <br /> (Draw existing and required addition on reverse side) <br /> I 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 <br />,E as to become subject to Work n's Compensation laws of California." <br /> Signed --- --------- -`---------- Owner <br /> BY <br /> --- ---- =------- Title ---------------- ------- <br /> - ------------- ------ -- ----------------------------------------------- <br /> (If other than owner41 <br /> ) <br /> _ FOR . PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----�T-� -���� ------------------ ------ --- -- ---- -- ----- <br /> -----. DATE ------ ----------BUILDING PERMIT ISSUED ----------- ----------DATE -----I---------------------------- -------- <br /> ADDITIONAL <br /> ---'------ <br /> ADDITIONAL COMMENTS ______. _ t <br /> ----------- -------------------- -- --- -- -- ------------------- -- --- -=----------------------- ---------------------------------------------------------------------------- <br /> ------------------------------------ ------ --------------------- -- - ----- ---- - ----------- ----- - ------ ------- --------------------------------- -- <br /> ------------------------------------ ---- --- ----- -- -- --- - _ ---------- ---- -------- ------- ------------ -------- <br /> Final Ins tion by: - ---.Date _-- -------��- -_-- <br /> i SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br /> I "� <br />