Laserfiche WebLink
FOR OFFICE DISE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. .7.�s:.:�S:7 <br /> lComplete in Triplicate). <br /> This Permit Expires 1 Year from Date issued Date Issued .................... <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 ond.existing Rules and Regulations: <br /> , <br /> JOB ADDRESS/LN . u <br /> .....CENSUS TRACT . ' <br /> Owner's Name _ Phone ...---•• Q <br /> Address ................. .c <br /> .t..�..ix_.. City _ ----------- <br /> W <br /> ��yy zz <br /> Contractor's Name ...... . <br /> . ....... .. .__ -... •------•• ----------•- _------- -------License#/".r. Phones --- <br /> Installation will serve: Residence 0 Apartment House E] Commercial❑Trailer Court ❑ <br /> Motel ❑Other........... ................A ........-- . ' <br /> Number of living units:.... ... Number of bedrooms .._`:Garbage Grinder ------- Lot Size ...— ................ <br /> Water Supply: Public System and name .........................................................—...................................................Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt o Clay ❑ Peat Q Sandy loam O Clay Loam f] <br /> Hardpan AdobeA Fill M6terlal ............if yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse aide.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer`s available within 200 feet) <br /> PACKAGE TREATMENT f SEPTIC TANK Size.-.-.... ..............•--_---- Liquid Depth <br /> [opacityl____-_ ._.. _-':Type= ------- -- -== Materials --� <br /> :.. No. Compartments ........-............. <br /> 1�istance,.to nearest: Well ....... �.� `..............Foundation ......� ........__ Prop. tine s......__.._...� <br /> LEACHING LINE Na�os __ <br /> f_Line .��.'.* ._.._.,Length of each line-------. 9 r <br /> ............. Total Length /�. ... . . ...... <br /> 'D' Box - ype I<llter.Matericxl'� ..De..Depth Filter Material •, <br /> _ .p ..... �.. _. <br /> Distance to nearest: Well .......4040 � � ` <br /> �•_-. Foundation ___. -�- t`.:-. :..,.PropertyLina ../`..... <br /> 'SEEPAGE PIT Depthl ._._ ._-•--- Diameter -, 3_�--__-- Number .._.. ._:#.......'Rock Filled Yes No <br /> ... I <br /> Water Table De th ......................Rock Size 3 <br /> Distance to nearest: Well .__.-/-Cly --------Foundation .-../4.-r... Prop. Line .. .............� <br /> REPAIR/ADDITION(Prev. Sanitation Permit -- Date ..................................I op <br /> ,Septic Tank (Specify Requirementsl ----... ...---•••-••.............................•--.....••----......------...,..............--•------••-----....------..�...._....-------- <br /> .� C , <br /> . . pA <br /> DisposalField (Specify Requirements) '-------- ---------------------------------------------•----•---••--•----------------..-.......---- -•-•------------- ---- ---•-----Od <br /> _: _. <br /> v" � ; <br /> i <br /> '----...._.•_._.--'-' i-•-_-dIE.>_- -----•:•-•--------'•----•---•---•--'---•..................................................'-•-....................._..._.._..._._.:............................. <br /> • �f:t ,It a.Q (Draw existing and required addition on reverse side) <br /> I hereby certify thatkl hie prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, Stataaws, and Rules and Regulations of the San Joaquin Local Health:Dishict. Notne owner or licen- <br /> sed agents signature certifies the following:. <br /> -A;I certfsfy-that'in the performance of the work Far 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 -------- -----• r <br /> ' 1 <br /> Owner <br /> BY `.---- ---•-------------------------------- Title -----...�.... ...................... <br /> lif oth an owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---........... ----------------------­- ----------­---------------- ----. DATE - .•-�1�. z� ��......------- <br /> BUILDING PERMIT ISSUED ...--- -• -- _--•--• _DATE .-----•---- . <br /> ADDITIONAL COMMENTS = -..... <br /> .. ................. ........ .......................................... <br /> ...._ ` . __..-.---.- <br /> . ._ a <br /> Final Inspection by: -------------------------•-----------------------.---•-._...._- ----- ------- -..-._._.. ate -•-•- --- --7..5................ <br /> EH 13 2h 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M <br />