Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> (eotnpbte in Triplicate) ` Permit No, _ <br /> ---------- .-. .. .__.. -_-- ...r__________ ___ n Y <br /> -___-:_-__-___-__ --------------------- j This Permit Expires 1 Year From Date Issued <br /> 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 /> A described.This application• ipade in compliance w'th County Ordinance No. 549 and existing Rules and Regulations: <br /> Lir �w �'W"' T�+ .4" a <br /> --___-_CENSUS TRACT _f`'j6....:.......... <br /> n�OB ADDRESS/LOCA -- -�� ---�-� -- --+r-------- --�- ------ <br /> -- ---- --- ----- -- -'- <br /> / = Phone .-b-- a- <br /> Owner's Name ---- ------ ----- •------------ <br /> Address City- - <br /> # �� cPhoneo Contractor's Name ---- ------ -.License <br /> Installation will serve: Residence❑Apartment House❑ Commercial ['railer Court ❑ <br /> Motel ❑Other _A/V " i ------1-1-`----t-•-- <br /> Number of living units:--------- Number of�bedrooms -------------Garbage Grinder ------------ Lot Size ___________________-_-__.__-_-_--__--•-.- <br /> Water Supply: Public System and name-------•-------- - — - Private <br /> Character of soil to a depth of 3 feet: Sand''❑ Silt(] Clay ❑ Peat❑ Sandy Loam ,A Clay Loam;❑ <br /> Hardpan ❑ Adobe.Q 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 j ] SEPTIC TANK:[k] Size__$0•' _46.,7(.-1 --------- ------------ Liquid Depth .-/--------------------- V <br /> Capacity _#0,00----- Type _COw- _ Material_____________________ No. Compartments .... ......... . <br /> Distance to nearest: Well ------ _: Foundation Prop. Line _ <br /> LEACHING LINE �] No. of Lines ------3-----.-_--_._ Length ;of each -----Foundation <br /> 1-0A. fadf Total Length <br /> f <br /> 'D' Box ---/------- Type Filter Material Depth Filter ,Material --- �l ------•- _---------•--------- <br /> Distance to nearest: Well -1-4,a_ Foundation Property Line a .............. <br /> SEEPAGE PIT ] Depth ---- Diameter ___..__. Number ------6----------------- Rock Filled Yes No i❑ <br /> Water Table Depth -----,- ------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ------------------- ------------------Foundation ----------- -------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date _-_____.-_-______-__._-.__--___._.) <br /> Septic Tank (Specify Requirements) ----- -----------------------------=----- ----------------------------------------------------------------- ....-------------------------- <br /> Disposal Field (Specify Requirements) ----------- :> ------------------------------------------`--------------------------------------------------------•--------------- <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 -------------------- J- ---------------------- Owner <br /> nn`lf <br /> BY '1 r'1 _: Gni - Title ------ -------- -------- --- ------------- <br /> (If other4ta owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - - a --------------------------------------------------------- DATE -I f- - Y--------------- <br /> BUILDINGPERMIT ISSUED --------=---- ----------------------------------------------------------------------------------------DATE ---------- ---------------------------- <br /> ADDITIONALCOMMENTS------ '_--------------------- ------------------ -------------• -------- ------------ ------------------------------------ --------------------------- <br /> ----------- ------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------- ------------------------------ ----------------------------------------------------- -------------- ------------------------------------------------------------------------------------ <br /> 9 __________________________________________ _ ______ __ -_____ _^___-_ _ .._ __._.._-_..._--__.-._ <br /> ____-..._`______._. _ _ _ - - _ - _ _____ GAJ" <br /> Final Inspection by: - -- ---- ------Date `-------1� 7r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7 <br /> E. H. 9 1-'68 Rev. 5M <br />