Laserfiche WebLink
� w T <br /> FOR OFFICE USE: <br /> �p lbAPPLICATION FOR SANITATION PERMIT <br /> -------------------- (1 �� <br /> V (Complete in Triplicate) Permit No _____________________. <br /> --------- --------- --------- ------------------- <br /> Date Issued <br /> ------------------- --- <br /> ------------ --------------- <br /> -------- This Permit Expires 1 Year From 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 .. � -ft"� _-------------------CENSUS TRACT --------------------- <br /> Owner's Name ----- ------' l: i -�----------------------------------- ---------------------Phone ------------------------------------ <br /> Address -------- = `----- ----- -- -- ®---- ------- -------•--. Cityle_e�e,1e�---- --------------------------------- <br /> Contractor's Name ._____ r,0/6710:V/ ,� _________________ _ _ ___License # ? 0 9 Phone <br /> Installation will serve: Reside ice,g Apartment House❑ Commercial []Trailer Court ;❑ <br /> Motel ❑Other _-- --------------- <br /> Number of living units:-_,/-__-_ Number of bedrooms ..-----Garbage Grinder l __ Lot Size /' -. _ .......--- <br /> Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private X <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe X 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 [ ] Size-----------------------------------_------------ Liquid Depth _______-_----___-__,_-_-- <br /> Capacity ------------------- Type -------------------- Material,---------------------- No. Compartments ...................... R.r <br /> Distance to nearest: Well ____-___-__-______________________Foundation ---------------------- Prop. Line ---- -.- <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 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) ----------------- ------- ----- ---�-/-------•-------- ------------------------------- --- -• ----Disposal Field (Specify Requirements) -- __ :'_.._ ? -✓---' ------------___ �` <br /> � . <br /> ---------- ,✓ 1 ----------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ----- - ----------------- ------ - - _- ----------------------------------- Owner <br /> By i <br /> --' ------� --------------------------------- Title _. <br /> (If r t an owner <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ - -a <br /> ----- -- ---- --- ------------------------------------------- DATE -- -- 1 ---------- <br /> BUILDING PERMIT ISSUED -- p�v-------- ------------------- / DATE - <br /> `---- ---------------------------------- <br /> ADDITIONAL COMME S9 �j/-`,� +- �a�T fir ��v -2f• �e <br /> - ?� GxLGcG dirs.� --G'i�( <br /> ----------------------=-------------- <br /> - / --- ----------- { ---------- - ----1'd <br /> -------- <br /> 4 <br /> J <br /> � v ------ <br /> ---------- <br /> Final Inspection by: --- ------ t---- --- - --- ..�.--- .. Date f <br /> --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT W 11C <br /> E. H. 9 1-'68 Rev. 5M <br />