Laserfiche WebLink
t <br /> P R OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> -- --------- _------- -- Permit No. <br /> (Complete in Triplicate) <br /> =---------------------------- <br /> ---------------------------------------------------______ This Permit Expires ] 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/LOCATION ........52.16---------6E------ CENSUS TRACT -------------------------- <br /> I j� Phone ------ `-" 3_ -%-- <br /> =f=�`�� <br /> Owner's Name ------------E/--�'�------ �����,�����---------------------------------� - -" - <br /> Address !---------- ...... ------------------------------------------ City - -------------------------------- <br /> Contractor's Name -------------- -------------------------------------------------=--------License # --------- ------ Phone ------------------------------ <br /> 7 <br /> Installation will serve: Residence N Apartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of'living units:------1---- 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: Sandf] Silt❑ Clay .❑ Peat❑ Sandy Loam -M Clay Loam...O <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,) pp <br /> PACKAGE TREATMENT [ I SEPTIC TANK'[ ] Size----------------------•------------.------------ Liquid Depth ---------------------.-.--- JV <br /> Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ----------------.----- <br /> Distance to rXst: ell --------- ---------- -_ ._-��•----Foundation ---------------------- Prop. Line ----------:--:- ---•-- <br /> LEACHING LINE [ ] No. of Lin ----- -Z Le th of eacl�/line ----- - ----- _,___-_____ Total Length :--------------------------- <br /> t <br /> ---_---__ <br /> ' Cf h er Material ------------------------ <br /> ,ox <br /> D - erial ept <br /> Distance to nearest: Well ------------------------ Foundatto Property Line. ._-___-......___-_._.... <br /> SEEPAGE PIT [ ] Depth ---------_--__-__ Diameter ________________ Number .............. <br /> ock Filled Yes ❑ No .0 <br /> WaterTable Depths ----------------------------- ------------------Rock Size -------------------------------- 1 <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --------------........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------_"�----_____---_-_____--] <br /> Septic Tank (Specify Requirements) ------------------- -----------------=-----�-------------------------_- :n-------------------------I--------------------------- ' <br /> - 1 <br /> Disposal f=ield (Specify Requirements) -------- ------ /` ---------ff..-...... .s..... ------------ <br /> --------- -YC.5_1•_a;,9---5X aT_e' ------------------------------------------------------------------------------------------------------ -------1------------------•----- <br /> -----------------------------------------------------------------------------------------------"------------------------------------------ <br /> (Draw existing and required addition on reverse side) <br /> I 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 beco subject to.W rkma 's Co pensation laws of California." <br /> �filr- k <br /> Signed ---- ---- ----------------------------------- Owner <br /> By ------------------------------------------------------------------------------•------------------------ -fit.le ------------------ -------------- -------------------------------------- <br /> (lf other than owner) <br /> FORD PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------------------------------------------------" DATE --- -------•-•--- <br /> BUILDING PERMIT ISSUED ------- DATE ------------------------------- ---------- <br /> ADDITIPNAL rCOMMENT,S t�v 4" c•ek e �' o�z 1 F o» E' ctr = <br /> 'mow In r -----;1., � # c-u_f - <br /> =---------------- <br /> pby: <br /> \H. <br /> na1 Ins ection -------------------------------------------------Date 1l'S''SAN JOAQUIN LOCAL HEALTH DISTRICT, 9 1-'6$ Rev. 5M <br />