Laserfiche WebLink
FOR OFFICE USE: - � <br /> APPLICATION FOR SANITATION PERMIT:,. <br /> --------------------- .�., Permit No �p <br /> (Complete in Triplicate) <br /> --------------------------------------- _l-=l <br /> This Permit Expires 1 Year From bate Issued bate Issued <br /> .= J <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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: t <br /> 1 <br /> * 1' <br /> JOB ADDRESS/LOCATIO _-'' �?"`'_-- _ -- . - - -=--c ±oLc.G------ - a.r.r x.c__Gtf.�I{,aQs�ENSUS TitACT -------------------------- <br /> Owner's Name �CrI�___ -`----- ---- ------- ------i- ------------------------------'---•---------- ---- ---- Phone <br /> Address ---- �-lP .-- - ------ --- ---------- -------- __'City -------- <br /> ----- -• ----------------------.----------------- i <br /> Contractor's Name ;------- ----- r J- ---� ."-.�----- -- ---- - -------- �-.License #lit Phone <br /> Installation will serve: ResidenceAApartment House f] Commercial :❑Trailer Court i❑ <br /> { Motel ❑ Other - ------------------------------------- <br /> Num ber of living units:--- Number of bedrooms ------ Grinder ------------ Lot Size . ------ �_-__/___-__- <br /> Water Supply: Public System and name ----------------------•------------------ ------ -------------------------------------------------------------Private �S <br /> Character of soil to a depth of 3 feet: Sand'E] Silt C] Clay Peat❑ Sandy Loam ❑ Clay Loam ,E] <br /> Hardpan ❑ Adobe '❑ Fill Material ------------ If yes,type ----- <br /> (Plotiplan, 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- til_! _�.._�'��_._�- Liquid Depth _T-._.________________ <br /> s i Capacity --�v �:e- Type -Material No. Compartments -------- ------- <br /> e"' <br /> ------ ---- <br /> s } <br /> Distance to Weare t: Well -------------�d--------------Foundation ------/®-f_____ Prop. Line ___--�___f_:__._..._ <br /> ,�a <br /> LEACHING LINE�, �[� No. of Lines _____�____________ Length.of each line-____���-�__..____ Total Length ____________________________ <br /> ` D' Box - te <br /> _ Type Filter Material ' ___�__�____Depth Filter Material -____. �1________________�_-__._Distance• t_ arest: Well '_`. o__ _____ _ Foundation -----/0-------- ----- Property Line __5'________ <br /> ' t I'' '� ��' ----- ----------- --� Filled Yes .[ No C3 <br /> SEEPAGE PIT'7 .[ - Depth Diameter r !Number f Rack <br /> Water Table Depth ----------------54--------------------------Rock Size w X------------------- <br /> el <br /> -- ------ <br /> :'Distance to nearest: Well ----------------/_0.0---------------Foundation Prop. Line ____-__--_______ <br /> REPAIR/ADDITION(Prey: Sanitation Permit# -------------------------------------------- Date.---------------------------------- <br /> Septic Tank`[Speci'fy.Requirements) ------------=------- ----=----------------------------------------------------•--------------------- <br /> Disposal Field,;(Specify Requirements) ------------ -----------------------------------------I--------------- <br /> 1 <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 /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------------- ----------------- ----- - - Owner 1 <br /> T� - Title �. �" ------- <br /> ------------------ <br /> (If of er than owner} <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----± --------------------------- ----------------------------------- DATE 7-_ --------------------------------- <br /> BUILDING PERMIT ISSUED ------V-------- ----------------------------------------------------------------------------------------DATE ------ ------------------------------------ <br /> ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------ -------------------------- -------------------------------- ------- <br /> --------- ------------------------------------------------------------ ---------------------------------------------------------- -------------------------------------------------- - -- <br /> -------------------------------- ` --------------------- ------------ - - -------- <br /> Final inspection by: ! -----------Date --- ---------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />