Laserfiche WebLink
10 .. <br /> FOR F .I U - APPLICATION FOR SANITATION PERMIT <br /> ----------------- """- ------- Permit No 7 <br /> (Complete 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 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION CENSUS TRACT ________________________ <br /> o--} ------ ----- - <br /> Owner's Name -://�1> 1C 1 ��Q `.�L 2�- -------Phone - _1- As Oj <br /> -- <br /> Address .0 Q � > .� -. City -- - ------ ---- -------- f ------- <br /> / ` <br /> Contractor's Name . ._ �T 4r. ._ �_ __ ___________ r---.License #f� -�S/l_ Phone <br /> Installation will serve: Residence IgApartment House❑ Commercial ❑Trailer'Cowt ;❑ <br /> r <br /> a Motel ❑ Other. -- ------------------------------ 11 <br /> Number of living units:-�_----- Number of bedroom - ------- Grinder _A --- Lot Size .-_%TsX0 <br /> Water Supply: Public System and name __rn -------------------------------------------- --------------Private ❑ <br /> Character of soil to a'depth of 3 feet: Sand'❑ Silt❑ 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 200 feet,) <br /> PACKAGE TREATMENT { SEPTIC TANK nn Size.-SX.17------------------------------- Liquid Depth <br /> I . ..--._-__.-.------- <br /> Capacity _)RDU_-,__,Type . _:___-- MaterialNo. Compartments ------ <br /> ,_.._. <br /> 9....... Q <br /> Distance to nearest. Well- -----------------------------------Foundation ---------------------- Prop. Line ....................... Cl <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 ---------------------------- Mock filled Yes ❑ No 0 <br /> Water Table Depth ---60--f---`------------------`--------Rock Size -------------------------------- <br /> Distance to nearest: Well ------------I---------------- ---------Foundation -------------------- Prop. Line ---------------------. <br /> Alit/AUDlNON(Prev. Sanitation Permit# ------- D--------------------- Date -----------------------•--•....... <br /> ) <br /> F _ <br /> SepticTank (Specify Requirements) -------------------- --------------------------------------------- ------------------------------------------- ,.--------------------------- <br /> Disposal Field (Specify Requirements) ------------ ------------------------------------------------------------------------------------•--------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ <br /> ----- <br /> - --------------------------------------------- <br /> r (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 be a subject to Workman's Compensation laws of California."Signed A� '--------------------------------- Owner <br /> BY ------ Title�E- .-- ------ <br /> - - ----- --- - - -- --------- ---------------------- <br /> f other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---- 1 <br /> ----- --------------------------------- DATES. Z� ; <br /> BUILDING PERMIT ISSUED ------ <br /> --- -------- ------------- -----------------------------------------------DATE ------------------------------------------ <br /> ADDITIONAL COMMENTS -------------------------------------------------------------------------------- <br /> ------------- ----------------------------------------- ----------------------------------------------------------------------------------------------------------"-------------- <br /> ----------------------------------------------- ---------------------------------------------------------------- ----------------------------------------------------------------------- <br /> ------------------------------------ ------------------------------------------------------------------------------------------- <br /> FinalInspection by: ------------- ----------------------------------------- ---------------------.Date ---3 _.. _ ._-7 ------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />