Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ....................=..... ..... _ <br /> �i Permit o <br /> -------- <br /> (Complete In Triplicate) <br /> ...........................I.............................. This Permit Expires ] Year From Date Issued Date Issued <br /> Application is hereby ma"ie 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 /> JOB ADDRESS/LOCATIO N. _ .l .. ....:_ -•_: -+� ---_----------- <br /> CENSUS TRACT .............. <br /> Owner's Name ._........ - ---• :� . �(i1,'....... = ...............Phone ..` �_ _ /a,.�...-- <br /> .... . _._. _ . <br /> Address .-••-•-••----------. . ___. '::.r - .... ........ City . <br /> rl - ............................................ <br /> Contractor's Name ----------------• -:-••-• -- -- -- - - . ----...........License # .: - .... Phone <br /> 6" . <br /> fInstallation will serve: Residence Apartment House] Commercial flTrailer Court <br /> Motel [3 Other <br /> / f <br /> r Number of living units:.., ...... Number of bedrooms ...5__-Garbe a Grinder Lot Size <br /> 1 - <br /> Water Supply: Public System and name ................:..........................................................fL ................Private 0 , <br /> Character of soil#o-,a..deptcf,1_feet: Sand's Sllt❑ Clay E] Peat o Sandy Loam p Clay Loam x <br /> Hardpan [] Adobe p Fill Material ............ If yes,type ..._....................... <br /> ih t <br /> (Plot plan, showinag size of lot, location---of-system'--in-relation-twwells;buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 204 feet') <br /> PACKAGE TREATMENT ( ] SEPTIC TAWK Size..... :"""" `�I .. L id�Depth1.................. <br /> Cap ty Type . Material.. _. _ . <br /> aci ..:.__-- YP -- -------- �"��.... No. Compartments ... ........___ .— <br /> - -'• I <br /> Distance to �eare�` s 1Neil .._-•-...................—....Foundation ---- 0............ Prop. Line __• _;............. <br /> r <br /> LEACHING LINE [ 41 of Lines <br /> r ............. Length of each lina . <br /> . :..__ Total-Length / ......,...,...5 <br /> 1 <br /> F D' Box ..Type••Filter-Mkaterial --V` 2....Depth Filter Material ....� <br /> Diiiistance to nearest:Well .............:....... Foundaticn�_,....ld.�..._._.__ Property line ....- .............. . <br /> __ <br /> SEEPAGE PIT Depth ...Z.Q.1....... Diameter Number ............:A . ......... Rock Filled Yes V No <br /> m � - `1111atGr-Ttiblw-De th _.._ �r/r <br /> 44.,e S P --_ _i..._-- ...Rock Size _ �l�.....�Ile...... <br /> Nt3-,-DDi to nearest: Well , ' t ti _.._.._ ................Foundation...... <br /> .- :lQ_.f -Proof 'line .. .r - <br /> REPAIR/ADDIT#ION(feyr"`' �nitatiori Permiti# -------..--•--.� ----- --. Dare .•-----.. . _I ' ..G <br /> Septic Tank {Specify Requuir min .........--- -- ------­----------I --------- ......... ....... . ....... <br /> {. a ents <br /> Disposal Field (Specify Requirements) <br /> - -=- "' =-••�• � �r <br /> R <br /> -----------••---- ............................................................. . <br /> --------------------------------- ................ <br /> (Draw existing and required addition on'reverse-fide) <br /> I hereby certify that I hav, 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€Sun 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 become subject to Workman's Compensation laws of California." , <br /> Signed ---..._...- <br /> ---- <br /> ---- -------- - -------------------_ ---------------- Owner <br /> �' Title -- <br /> By .._._... .......... ........... . <br /> othe t ori owner) <br /> -- ------------------------ <br /> FO DFP 'itT T US O LY <br /> APPLICATION ACCEPTED BY ._ .:......... <br /> BUILDING PERMIT ISSUED ' �7v <br /> ADDITIONAL COMMENTS !-- -----•--•---.-----•- ---------------• . ................... <br /> .........._..-..............:..._.._..:.................. -•-................_....... <br /> ........... .......................... !M;:.... :.._ <br /> .... .....................• ------ .... <br /> .................................. ___- --• ---- <br /> ' ` � ... <br /> Final Inspection by: ._ ... ......................... . ..,..._._.._...----' _. •--.............. <br /> ...........................................Date ., ..... .Z�. 7 .................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t <br />