Laserfiche WebLink
FOI,OFFICE USE: <br /> . �- APPLICATION FOR SANITATION PERMIT <br /> Permit No. Y <br /> ( (Complete in Triplicate) <br /> ------------------------------- -.... ­ ..w.-...,�.W. r --�....r.�-- _. •- . <br /> Date Issued -------------- <br /> _ <br /> -_.._______ - This Permit Expires 1 Year From Date Issued <br /> ___ . .. <br /> __________________________ __________�____- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the worVherein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION L-----------' -----' ------------------------ --- --!-CENSUS TRACT, --------------- <br /> Owner's Name --- " <br /> _P.hone< 3_._lf--....__ <br /> Address _ --� - ----------------- City ' <br /> Contractor'sham i ------- ---- <br /> e �'� gLicense # -5 7 Phone <br /> Installation will serve: ResidenceAApartment House❑ Commercial :❑Traller Court ;❑ <br /> Motel ❑Other------------------------------------------- <br /> Number of living`units:___________ Number of bedrooms __3____Garbage Grinder ------------ ',Lot Size ___ ____________________________________ <br /> Water Supply: Public System and name ------------------------------------------------------------- ----- \ <br /> ------ ----------•--------------------Private f <br /> � <br /> Character of soil to a depth of 3 feet: Sand'[ Silt❑ Clay ❑ Peat ElSandy Loam 0 Clay Loam ❑ <br /> y.� Hardpan ❑ Adobe ❑ Fill Material ---------1--_'If yes,type ---------------------------- <br /> r _ <br /> s (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: jN&septic tank or seepage pit permitted if pvb-lic-s`ew�er 's7available within 200 feet,) <br /> h ti l J <br /> PACKAGE TRI:ATMENTr.[-}.�`, SEPTICTANK�[ ] Size_._:1�--------- - ----------------- Liquid Depth ----T---------•-.------ }� <br /> ,r <br /> r g Capacity.l_� _ ;Type 4-�_____- ---- later,ial---------------------- No. Compartments ----- ....... <br /> �r a to nearest.'\e l ----� '--- r- "----------Foundation ---- Q----------- Prop. Line __5 -- ---.---- <br /> { Distant ti . <br /> LEACHING LINE [ ] `N.o. -'UPA. ;y -- ---------------`Length+ of each line----- -------------- Total Length-, -- ------------------- <br /> x lBox. .________ ,Type Filter'Matericil _____Depth Filter Material -__-J�______-------------------------- <br /> D' <br /> Distance to nearest: Well ___90 ______________ Foundation ___»-___-_______ Property Line _:_____._________....___ <br /> SEEPAGE PIT I ) Depth --------'._--------- Diameter _______________ Number ---------------------------- Rock Filled Yes E] No .0 <br /> ' Water, Depth - ---------------------------- - ------------Rock Size -------------------------------- <br /> .�.w.� Distande to nearest: Well --------------------- ---------------- --Foundation -------------------- Prop. Line = r <br /> REPAIR/ADDITION(Preva Scjnitation-Permit# _...----------------------------------=----- Date ---------------------------------- <br /> . <br /> SepticTank (Specify', Requirements);:--------------------------------------------------------------------------------------------------------- •---------------------- <br /> Disposal Field (Specify. Requirements) ---------------------------•-------------->---------------------------------------------------------------------------------------- <br /> .l <br /> =' -, <br /> --- - -- ------------- <br /> -------------------------------- <br /> ---------- _ _ <br /> y,., ' I- ;1 t -- . <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 Hcen- <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 become subject to Workman's Compensation laws of California." <br /> I <br /> Signed <br /> /------------- { ------- v- --� ------------------------------- <br /> Jif <br /> --------•--------------------------- Owner <br /> Tite <br /> .By -------- ------------- <br /> (If <br /> other than owner) <br /> FOR DfOARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - - - ------ - - DATE _-�'a--- <br /> BUILDINGPERMIT ISSUED ------ ----------------------- -- -------------------------------------------------------=------- - ---DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS --------------------------------- ----------------- ---- -------------------------------=----------------------...._. <br /> -------------------------------------------- <br /> -------------- ------------ -------------- ---------- <br /> -------------- -- -- - <br /> ___________________________ ______ _ ___ ___ _ __ ----__________-________ __ _ ________. __ _ _ _ ___________-__ --------- ------------ --------- <br /> :. <br /> FinalInspection by- -------------------- _ --------------------------------------------------------------------__Date -------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ' E. H.'9 l-'68 Rev. 5M <br />