Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> --------------------------------------------------------- (Complete in Triplicate) <br /> --------------------------------------------- <br /> 14- <br /> ----------------------------------- -- Date Issued / ���• <br /> - ------- `This Permit Expires 1 Year From Date Issued , <br /> Application is hereby made to the San Joaquin Local Health District for a per to 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 /> ' JOB ADDRESS/LOCAT NIv--�`3-------- -------- - - - - -/---- - <br /> ---- -- <br /> ------- ---CENSUS TRACT ---�-�-�-------------• <br /> i Owner's Name <br /> - - -- --'-�`"�--------• Cit -- - _-- - ---••- <br /> 1 - ------`�-- y <br /> �. Address ' ----- ----------------------- <br /> ------------------------- --- <br /> Contractor's Name .- --- - <br /> x License # I���I Phone :. <br /> nt House Commercial-.8Trailer-Court-�;❑--- ------- ' <br /> id A artme ❑ <br /> Installation will serve: Res [� P <br /> Motel ❑Other -------------------`-------- -------------- ' <br /> - . <br /> Number of living units:---/-_--- Number of bedrooms_ --. ------Garbage Grinder ._------___ Lot Size,------------- -• <br /> E ° f,- -Private El Supp --------------------- <br /> ly: Public System and name - <br /> (.� <br /> Character of soil to`a depth of 3 feet:-•-Sand'Q ❑-SiltClay v❑ -peat El Sandy-Loam Clay Loam <br /> tAdobe <br /> r_o e Fill Material --------- _If:yes fiype-----_--- y"' <br /> Hardpan ❑ Adobe'❑ �. # <br /> (Plot plan, showing size of lot, 1&;a ion of 'system Ein relation to wells, buildI C14 <br /> ings, etc. must be placed on reverse side.] <br /> ' NEW INSTALLATION: (N6 septic tank:or�see page pit permitted if public sewer available within 200 feet,) ` r !r t^ <br /> �• -1 <br /> Li uid Depth _-_ -- ----•----• <br /> PACKAGE TREATMENT SEPTIC TANKS-MI — Size,- - <br /> -- �--�1--�f�--- tq P }� <br /> r- <br /> c__1_ ""Material=:e`s - No. Compartments <br /> Capacity--- ------- <br /> Oil pe Q�f F- <br /> r f <br /> -� Dist6nce,.to-nearest: Well - -� ?.-- f'-----------------Foundation ---- --------------- Prop. Line J--------- <br /> a- ?✓� <br /> No. of Lines Length of each line-_-_ Total-Le ---- --------• <br /> LEACHING;LINE `( <br /> r -- r C --- De th Filter.Material ---IS---•--------------- ------- <br /> 'D' Boxy .- -�T.ype Filter Materal _. i p , <br /> D stance to nearest: Wel I- ?---�1"------- Foundation' la--t--------- Property Line. -------------------•---- <br /> t No 0 <br /> SEEPAGE PIT [ ] Depth Diameter _______:-_ "`Number ---------------------- ----- Rock Filled Yes ❑ <br /> -=------------ �. <br /> -------------------------------- <br /> Water Table Depth ---------�f ---------------------------------Rock Size <br /> Distance to nearest: Well ----------------------------------------Foundation ------------------ Prop. Line -------------------•-- <br /> I t � <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------------------------- Date ----------------------------------) <br /> [ , F <br /> Septic Tank (Specify Requirements) -------------------_-------------------------------------� , <br /> Disposal Field (Specify Revirernents) ------------- <br /> ----------•------------- <br /> ___________. � <br /> �- ____________ - - --------- ------------- <br /> - <br /> {Draw existing and required addition on reverse side] <br /> I hereby certify that I have prpnred 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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------------------ :- - -- - <br /> i 1 Owner <br /> F <br /> ----------------------- ------------------------- <br /> Title Tit <br /> By - ------ -- <br /> le _.. <br /> (if of r han owner) <br /> 1 FOR .DEPARTMENT USE ONLY <br /> DATE p----- ------------------- <br /> APPLICATION ACCEPTED BY _-r �..� <br /> BUILDING PERMIT ISSUED .------.' ----------------------------------------------------------- <br /> - DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS .------------- - <br /> --------------- --.- <br /> ----------C-->-- <br /> ----- <br /> --------- -------- ___-__----_- _ -----__------_ <br /> i ___ -_-_ . __ <br /> ___._--1_------ � --___________________________ -------- <br /> -- <br /> - _p <br /> - - <br /> - ------------------------- ------- - . >- - Date - Z--9--- <br /> ------------------------------------------------------ --------------------________________________------------------------------------------ <br /> ---_ ---------- <br /> Final Inspection by: --------- - -- ---- ------------ ----- <br /> SAN J6AQU114�COCAL''HEALTH DISTRICT y <br /> E. H. 9 1-'68 Rev. 5M - <br />