Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ---- --------- - ------ ------ - --------- - ------- (Complete in Triplicate) Permit No. <br /> k <br /> ------- -----------------------------I------ This Permit Expires I 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 Ordina ce No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ------CENSUS TRACT ---------------- <br /> ---- <br /> AA - -- <br /> -C -- -- Phone------- ---------------------------------- <br /> Owner's Namx/&" <br /> Address ---id- -AX 4 - <br /> _ ......... <br /> CWPSf ----- - ---- --- -------- _ ----- ----- . <br /> - <br /> Contractor's Name ---------------------------------------------- ------ —License _j_1_? Phone <br /> Installation will serve: Residence E]Apartment Ho'osb-0 Com.mdrcial :E]Trailer Court 0 <br /> Motel E]Other ---- <br /> Number of living units:_.__._._ Number of bedrooms _,A,--- Garbage Gunder _7 !Lot Size <br /> ------------------------- <br /> Water Supply: Public System and name -------------------------------------------------- ------- ------------- ------------------------- ------Private <br /> Character of soil to a depth of 3 feet: Sand'El Silt "play F <br /> Pedt,0 Sandy loam [/Clay Loam El <br /> Hardpan ❑ Adobe El Fill Materiel ------------ If yes,,type _..------------ ------------- <br /> (Plot plan, showing size of lot, location of system in relation to wefis.,'buildings, etc.; must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if pub* sewer is available within 200 feet,) <br /> 100 ra <br /> PACKAGE TREATMENT [ I SEPTIC TANK:[11_� S1zeY--—-------__� <br /> ----- Liquid Depth ------------- <br /> Capacity/�z_ Vlvl------ Type d'' Materid�164&' o. Compartments ------------------- <br /> Distance to nearest: Wea-00-1 --------------- Foundation /r-------------- Prop. Lini0.-----I------- <br /> le 101 <br /> LEACHING LINE No. of Lines _------------------- Length ',of each lk6 -70.------11--------- Total Length ------­------ <br /> 'D' Box Y. Type Filter Material Depth Filter Material --------------- <br /> -- - Foundation -------- -------- Property Lin <br /> Distance to nearest: Wed-4014) ------ <br /> "01! 140 .. .......0.10,........ <br /> SEEPAGE PIT Depth --- -- ------- Diameter ___s_ --- Numb6r ---------------------I-------- Rock Filled Yes :F <br /> I No 0 <br /> ------------ ----- <br /> Water Table Depth ------------------------ ----------- -Rock Size - <br /> Distance to nearest: Well ---------------L__;.------------- -Foundation;--------- --- ---I Prop. Line ------------- <br /> RIEPAIR/ADDITION(Prev Sanitation Permit# -------- -------------- -------------- i --------------- <br /> pate ----------- --- --- <br /> Septic Tank (Specify Requirements) __.-------------------------------- ,--------------­_­--------------- <br /> --------------------------- ------------------------- <br /> --- <br /> ,Disposal Field (Specify Requirements) ------------ ----------------- <br /> ----------------------- ---------- ------------------------------------------- <br /> --------- ------------ ------- --- - - ---------- -------------- 7Z- ----------------------------------- ------ <br /> -------- - ------ ----------- -------------------------- ----------------------------------- --------------------------------------------- <br /> (Draw existing and required additionOreverse side) <br /> r <br /> I hereby certify that I have prepared this application adcl 'that%,thd w®rg will be done in accordance with Son Jo <br /> 01"'n <br /> County Ordinances, State Laws, and Rbles and Regulations of the, Sar,J 'aquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the followl"g: <br /> "I certify that in the performance of the,work for which th"is'06rrhFt 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 `N --------------- -- <br /> ------------------------------- Owner <br /> ---------- <br /> r ---------------------- --------- --- - -- ------ �Tii <br /> By --------/1- - --- ------ tleti 7Z <br /> (If other than owner) <br /> FOR DEPARTMENT ,USE Obgy <br /> APPLICATION ACCEPTED BY ------- -------------- -- DATE <br /> —-------- -------------------------- <br /> BUILDING PERMIT ISSUED --------- ------------------------------=- <br /> ------------- -----------Z--------------DATE --------------- ------------ -------------- <br /> ADDITIONAL COMMENTS -------------------------------------------------------------------------------=-------------------- --------------------------- ------------ <br /> ----------- -- --- ---- - ------------------------------------------------------------------- -------------------- ---------- <br /> --------;-------------------------------------------------------------------- <br /> -------------- ----------------------------------------------------------------------------------------T,--------------------- ---------------------------------------------------------- ------------ <br /> --------------- ------------------ ------ --------------------- ----------- ------------------ <br /> ----------------------- -------1------- <br /> Final Inspection by: ---------v4d ----------- -------------- ------- ------ -- - -------- ------- Date ---------------------------- -- ------- <br /> ---------- <br /> SAN'JOAQUIN LOCAL HEALTH DISTRICT <br /> F 14 0 1-'AA P- FAA <br />