Laserfiche WebLink
FOR OFFICE USE: o APPLICATION FOR SANITATION PERMITI <br /> ermit No. _6-f�_77-� <br /> lComplete in Triplicate) b �,V * y, , ,er <br /> -------------------------------------------------------- <br /> ---- This Permit Expires 1 Year From Date Issued Date Issued &-1,=;2_-- <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 made in compliance with County Ordinance No. 549 and ex� Ilep aryd lotions: <br /> *>Og 4eur. 20. 4�r� <br /> JOB ADDRESS/LOCATI N . ---- --- -�S�0-----&_. A4_-__CENSUS TRACT --------------- ---- ----- <br /> Owner's Name ------ � �'r17�"I�'* ----- _ --------Phone ----------------------------•--•---- <br /> -� --------------------------- <br /> Address ------ o -Ill_---- - _ - 2 city----------------- ------------•--- ci ------------------------------------------- ------ <br /> Contractor's Name _ `------" ------------------------------------ ---------License # --- Phone ---- <br /> Installation will serve: Residence ORI(partment House°❑ Commercial ❑Trailer Court C] <br /> Motel ❑Other ---------------- --------------------------- _ <br /> Number of living units:----- ------ Number of bedrooms3_---------Garbage Grinder'"_______ Lot Size ___ _______________ <br /> Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------PrivateQ— <br /> Character of soil to a depth of 3 feet: Sand 23- Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam.0 <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 /> i <br /> PACKAGE TREATMENT [�EPTI C TANK'[ I ! Size____.?'�_ __X__}_Y_-- -.S_______ Liquid Depth __4-------------------- <br /> Capacity __/ 4t-- j.R ype - -3a"aterial__e No. Compartments ___-_�__-___:.__. <br /> Distance to nearest: Well ___�r+0 :�-`_-----------------Foundation /P Prop. Line _�__----0----------- r <br /> LEACHING LINE [L]' No. of Lines -----�------------- Length of each line----�?0----------------- Total Length <br /> 'D' Box �e_S Type Filter Material _1L fC____Depth Filter Material ___ ------------------------------ <br /> �J j <br /> Distance to nearest: Well __ __�___:�_____ Foundation 16------------------- Property Line -.57................. <br /> SEEPAGE PIT [ Depth -------------------- Diameter _______________ Number ---------------------------- Rock Filled Yes ❑ No <br /> Water Table Depth ------------------------------------------------hock Size -------------------------------- <br /> Distance to nearest: Well --------------------------------------..Foundation -------------------- Prop. Line _....... ........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) <br /> Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------------:- ---------_...---.--------------------------- <br /> DisposalField (Specify Requirements) -------------------- •-------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> 1 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 beta a subject to r an's Compensation laws of California." <br /> Signed - Owner/ <br /> By ---- --Title ---(__' _ <br /> -- --------- --------- ------------------------------------------- <br /> (If other than owner) <br /> JJ FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- ,PW4 4 , ----Ir-WO ----- DATE ---- --.----------- <br /> BUILDING PERMIT ISSUED --------------------------------------- ----------DATE ------------------------ <br /> --------------------------�------------------------=---- ------------------ <br /> ADDITIONALCOMMENTS -------------------------------------------------------------------------------- -------------------------------------------------=--------------------------- <br /> ---------------------------------------------------- ------- <br /> - :�20_ <br /> ------------------ ---- <br /> ------- - ------ <br /> ------------ <br /> Final Inspection by. ---------------------- ------------------------------• ------Date -- ter --- -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />