Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
- <br /> FO-R, OFFICE- -usE-- <br /> - - --------------- <br /> APPLICATION FOR SANITATION PERMIT <br /> -- -------- -- - -- <br /> (Complete in Triplicate) Permit No. <br /> -------------------------------------------------------- <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> --------------------------------------------------------- <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 /> � ,�,f <br /> JOB ADDRESS/LOCATION .-.- 5__- /-L.:.--L_.C+r�r"' ` --------------------CENSUS TRACT __S__`17------------- <br /> -- <br /> Name - -------------------m------ -------------Phone -- -------------- <br /> Address ------- _ F ------ ------------------ City --- -- -------- --------------------- -----------------P ------- ----•- <br /> Contractor's Name ` ` "" ` ' r------------------------License # - �"' Phone ----------------------------•- <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ',❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units:___-�16_ Number of bedroomsZf?�Garbage Grinder ------------ Lot Size ____��- —� `' <br /> - -� ------,-.,--/--------- <br /> Water Supply: Public System and name ---------------------------------------------------------------------- ---------------------------------Private [J <br /> Character of soil to a depth of 3 feet: Sand'[:] Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <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 240 feet,) <br /> PACKAGE TREATMENT f I SEPTIC TANK:[ ] Size----------------- ------------------------------ Liquid Depth ----------------..-------- <br /> Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ----------------•----- rr <br /> Distance to nearest: Well ____________________________________Foundation ---------------------- Prop. Line ---------------------- <br /> LEACHING <br /> ________- _-________LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ----_______-___---___-______ <br /> 'D' Box .----------- Type Filter Material --------------------Depth Filter Material ---------------------------------•---------- <br /> Distance to nearest: Well ________________________ Foundation ------------------------ Property Line ____-___-_________._.... <br /> SEEPAGE: PIT [ ] Depth ___________________ Diameter ---------------. Number ---------------------------- Rock Filled Yes ❑ No C3 <br /> Water Table Depth -------------- ---------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well _______________________________________Foundation -------------------- Prop. Line ..-.___-_-____________ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> Septiic Tank (Specify Requirements) _______-_____ .____-___ _ <br /> Disposal Field (Specify Requirements) _:__ <br /> -------------- --- -- ---- - <br /> ------ ---- --- ----- "-. ----------------------------------------------------------------- ------------------------------------------------------ ---- <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 become subject to Workman's Compensation laws of California." <br /> Signed ----------------------------eu��� <br /> ----- --- ------------------ Owner <br /> By ----------------------------- ----- -- <br /> - - -- --------- ---- Title ------ ------ �"' <br /> (If other than owner) <br /> od FOR DEPARTMENT USE ONLY �+ <br /> APPLICATION ACCEPTED BY - - - -- ------- ---------- -- <br /> ------------------------- ------------. DATE �� + y ���•------------------- <br /> - <br /> BUILDING PERMIT ISSUED ------------------------------------------------------------ - -------DATE -------------------------- <br /> ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------•--------------- -------------I---------------------------- <br /> ----------- -------------------------------------------------------------------- ------- -------------------------------------------------------- ----- ---------------------------------- ---------- <br /> --------'- ------------------------------------------------------ �� <br /> Final Inspection by: -------------------Datef_- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M' <br />