Laserfiche WebLink
-POR OFFICE USE: 1 <br /> APPLICATION FOR SANITATION PERMIT <br /> ....... i� .......... Permit No. <br /> This permit Expires 1 Year from Date Issued Date Issued <br /> . _7G <br /> Application is hereby made to the San Joaquin.Local Health District for a permit to construd 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/LOCATION ......... .....CENSUS TRAGI ......................... <br /> Owner's Name 13k-jj,,tjCA/Q,/ V. .5 .......................Phone ......------------......----•---- <br /> . s <br /> Address �-............. :. ........City ......:.................................• -........................ ---•-- <br /> Contractor's Name 2 4�1--- ----_ ____.License .......... Phone -----=-----------------------= <br /> Installation will serve: Residence W Apartment House 0 Commercial Otraller Court 0 k <br /> Motel ❑Other------------- ---- ...................... <br /> ti <br /> -.__._._ Number of bedrooms ......:.. ..... . .... . <br /> Garbage Grinder ..: ... Lot Size .....:.. <br /> Number of liningunits:__._ .... ............................... <br /> Water Supply: Public System and name .............................................................................................................Private Q. <br /> haracter of soil too depth of 3 feet: Sand o Silt o Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam i <br /> Hardpan 0 Adobe ❑ Fill Material ....... . !fyes,type ............... ............ <br /> , <br /> (Piot 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 avoilable within 200 feet,! F <br /> PACKAGE TREATMENT ( ] SEPTIC TANK Size................................................ Liquid .Depth .................... <br /> 4 <br /> Capacity ...... ype _Material---•-- NoN'Compartments .... <br /> Distance to nearest: Well ...................Foundation ....................... Prop. Line ..................71 <br /> LEACHING LINE [ j No. of Lines .................... Length-.of.,.each line...............,............. Total Length <br /> 'D' Box ............. Type .filter Material ....................Depth'Filter Material ........... ................................ <br /> Distance to nearest: Well Foundation ; Property Line l <br /> SEEPAGE PIT ( J Depth -------------------- Diameter .................. ............... Rock Filled Yes ❑ No Q <br /> �.--..,. . �..... -.. ---Rock Size ....................... <br /> Water Table�,Depth- •----------•................... <br /> ---•-•-----=-----±--------•--•- ......... <br /> Distance to-'nearest:Well ............... ...._ <br /> •• '..Foundation • •- . Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation.Permit# :-........:: ........ ........ Date ......................... <br /> Septic Tank (Specify Requirements) -------•------ :-- :...................:. ............ Y .. ............................. <br /> . .._.._..... .. <br /> Disposal Field (Specify Requirements) .- ----..�ll....._. �i: -.-` "_.:..- ---.X: --X:�l�....--- Lin ---• <br /> ............................... ................................ .... .........._.. ........................ <br /> ----------------- ------------------------------------------------ ----------------- -------------_..-...................................................................................... <br /> ..- <br /> _ {Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared'this application•,and,thatthe. work will be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heal&District. Hence owner or licen- <br /> sed agents signature certifies thefollowing: -- <br /> "I certify that in the oe rmonce of the work for which this permit Is issued, I shall not employ any person In such manner <br /> I as to becomes Uorkan's Compensation laws of California." ' <br /> Signed - --------- Owner <br /> By <br /> --------------------------- <br /> --------------------- ------1-1-- . <br /> (if other than owner! — 1 1. . -- .. r . . - . I <br /> FORDE TM N7 USE C / <br /> APPLICATION ACCEPTED BY _ = -------- ------- :-..#SATE 8.,"-- _` ------------- <br /> BUILDING PERMIT ISSUED ---------------------- ----------------••-•...---' DATE ... __. <br /> ADDITIONAL COMMENTS ---- ---- • - •----- ---•------ ---------- ---------- <br /> -------- .......... .:. . <br /> Final Inspection by': - ..._- ------ .�^......--- . Date -.. •— <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> t _ <br />