Laserfiche WebLink
• FOR OFFICE USE: - <br /> APPLICATION FQR SANITATION PERMIT <br /> --------------------------------•----------------- Permit No. -7Y--,5 75 <br /> -------------- <br /> (Complete in Triplicate) <br /> -------------------------------------------------------- <br /> This Permit Expires I Year From Date Issued Date Issued <br /> ----------------I-------------------------:--------------- <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 existing Rules and Regulations. <br /> --------- ----CENSUS TRACT <br /> JOB ADDRESSAOCATION ---TF__& -------4r� <br /> Owner's Name --------/I',- ------------------------------------------------------------------- ------------Phone---------------- -------------------- <br /> Address ------------------------------- ---------------------- <br /> --------------------------------------------- City ------- -------------------------------------------------- <br /> !l �Co - ( e 1s <br /> ntractor's Name/ <br /> ------------------A1A�J License #0y07f_Y----- Phone f60! ,aV....... <br /> Installation will serve: Residence 0 ApartmentH4se nercicl�raiCourC <br /> Motel EOther 0 - ----- <br /> Number of living units_____________ Number of bedrooms ______.___Garbage Grinder ----- Lot Size -------------------------------------------- <br /> Water Supply: Public System and name --------------------------------_----------------------- ----------------------------------------------.-Private El <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay E] Peat❑ Sandy Loam -E] Clay Loam-0 <br /> Hardpan E] Adobe E] 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 <br /> ,06Z, �� Size-------------------------------------------------- Liquid Depth ----------------.--------- <br /> ._V_ ype. .........6rNo. Compartments _SL---------- <br /> Capacity/ Material <br /> Distance to nearest: Well -:r __________________________Foundation 19�-------------- Prop. Line ----,r------ ------- <br /> LEACHING LINE No. of Lines ___/__________________ Length of each line/-----________-______ Total Length -------------- <br /> . %N) <br /> 'D' Box ------------ Type Filter Material -A*714?---------Depth Filter Material -if---Of--------- --------- <br /> Distance to nearest. Well ZAI---------------- Foundation __10--------------- Property Line ------- ----------- <br /> SEEPAGE PIT Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes C] No C] <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ____--_._____________________-____j <br /> i <br /> Septic <br /> ------ -------------------------- <br /> SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------------------------------------- <br /> Disposal Field (Specify Requirements) ----------------------------------------------------------------------------------------------------------------- ------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> (Draw existing and required addition on reverse side) J, <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Homo 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 becMSUb"10.1.t to'orkman's Compensation laws of California." <br /> j <br /> Signdd _p- -- - --- -- - --- -- -- --------------------------------- Owner <br /> By ----------------------------------------- - - -- - ------- ------------------------ Title ------------------------------------------ ------------------ <br /> (if other thanTwner) <br /> 4 A FOR,DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ �------------------------------------------------------- DATE ---------------- <br /> BUILDING PERMIT ISSUED -----: ----------------------- --------- ------- ------DATE ------------------------------------------- <br /> ADDITIONAL COMM ----------------------------------------------------------- <br /> ------------ <br /> ENTS <br /> ------------------------------------------------------------------­--------------------------------- <br /> ----------------------------------------------- ---------------- ------------------------------- <br /> --------- --------------------- ------------------------------------------------------------------------------------------------------------ -------------------------- ----------- <br /> ---------------------------- 14�1 __ __ / <br /> - ------------ <br /> Final Inspection b ------- Date --- �l - ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M, <br />