Laserfiche WebLink
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE: <br /> API'LICATIO FOR SANITATION PERMIT .3d/_ <br /> . .; Permit No. ........ :.......... <br />'._..?.. --.._.. ( �mplre in Triplicate) <br /> Date issued � f~ <br /> ........ .......................... Y- ....... <br /> This Permit Expires 1 Year From Date issued <br /> _........ ................... ...... <br /> t <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 /> ..-.1- ••._ j'` <br /> .....CENSUS TRACT .........::...:....•...... <br /> JOB ADDRESSAOCATION <br /> _ .__..._:. Phone .................. ...•--......._. <br /> Owner's Name ......................... <br /> Address ........ <br /> .. -••-••......•• City .....................................................................I....... <br /> 1 License # ......................... Phone ......................... <br /> Contractor's Name .......... .. ..... ....................:...................•--....----.....-=----•--• <br /> Installation will serve: Residence Q Apartment House Q Commercial QTraller Court <br /> [ Motel Q Other -• " jG'��' <br /> [ ...... <br /> Number of living units:............ Number of bedrooms -_- ........Garbage Grinder ...... Lot Size .....___....-•..._ siva-...... - .. <br /> Water Supply: Public System and name -------------------------- ........................ <br /> --- -- ---- ..... Private <br /> I Character of soil to a depth of 3 feet: Sand Q -Silt Q Clay ❑ Peat❑ Sandy Loam Clay Loam Q <br /> Hardpan ❑ Adobe.E3 Fill Material ............ If yes,type ............................ <br /> i (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 ] ` Size---------------------------------•.............. Liquid Depth ----.-..----........-- <br /> Type OA Material_ ?_ No. Compartments .�"- ••••-•..•--- <br /> Capacity S4 <br /> Foundation ..-•---•-•-••-•-••-•-• Prop. Line ...................... 0 <br /> Distance to nearest: Well ..---- ---•---•-•--•------•--•• I ! <br /> Length of each line.----��__,.X S .-. Total Length .....4P. � <br /> LEACHING LINE [ 1 No. of Lines ..._..�............. g <br /> 'D Box Type Filter Material .Depth Filter Material <br /> a . <br /> Distance to nearest: Well .-•..................... Foundation ........... Pro...•--._...-- p rttr Line ....•--•. .............. <br /> Diameter ._ Number ..._...__................... Rock Filled Yes Q No L7 <br /> SEEPAGE PIT [ ] Depth •-•----......_ <br /> Water Table Depth ......I...I........Rock Size ................................ <br /> Foundation Prop. line ...................... to <br /> Distance to nearest: Well '-"- .............. <br /> REPAIR/ADDITION Prev. Sanitation Permit# . Date ...................................I <br /> p Septic Tank (Specify Requirements) ........... -••--•-••----------••-•-------•-- •-------•••--••-•-•......-•---_ ............ <br /> t ...............•-•-•-•---.... <br /> Disposal Field (Specify Requirements) .....---••• """ ' <br /> --------•-----------•----•--------------•-•-•---- ................-------------------.----------------- .-.---.---------------•-----------•-----------------•-- •--- <br /> } _..... ...---•--•-••-------------------•. ------.....----._.I..._....__..I.....---... <br /> _....._I--------------•-- ---- <br /> (Draw existing and required addition on reverse side) <br /> ji 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 licew <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 WarkmyCompeln, ion laws of California." <br /> Signed .._1�,� `- Owner .Y --• ................ �isle ...............................................•---.....-----•••....... <br /> (If otherthan ow <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .._ .._ .... ............................. <br /> DATE ...._.. .7._5 ...".�r............. <br /> BUILDING PERMIT ISSUED --• ` ....................... <br /> ..........••...................••-•-••. ... ---• DATE - ......................... <br /> ADDITIONAL COMMENTS ............................................................. <br /> •............. .... -•.------••-•-•--..._.........._......----•--- ----.-•--............................Date ..`- ^�� J... <br /> ....................7. <br /> --- <br /> Final inspection by- ---- ----- - ---- •--....._._.... ---- ••-- ---- --- -----• --- - <br /> E SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7/72 3 M <br /> G u <br /> 13 24 Rev_ SM <br />