Laserfiche WebLink
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE: t. ,. FOR OFFICE USE: <br /> I APPUCATION 61t SANITATION PERMIT <br /> --- a � - <br /> (Complete in Triplicate( .:,. Permit <br /> h- <br /> Date <br /> .,:Issued_._ .f ... „ <br /> This Permit Expires 1 Year from Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. <br /> This application is made in rpmpliance with County Ordincice No.549 and exksttFtg isules and=-Reg lafions: <br /> . - <br /> -.JOB ADDRESSILCKATI - ------,-- - - :_.CENSUS TRACE <br /> Owner's Name - - Phone- / _ , <br />' --------------­ <br /> Address----- ----- ------ ------ -- --- City1 zip <br /> Contractor's Name'------- -- - --1- --------------------------- -_.-- ----License #_._'.27 ----Phone.__ �-__- <br /> Installation will serve: Residenct <br /> ;Apartment House ❑ Commercial ❑ Trailer Court ❑ ' <br /> / tel ❑ Other------------------------------ ;, r <br /> Number of living units:_ /-_........Number of bedrooms--------Garbage.Grinder------------Lot Size -------------- <br /> Water <br /> _-----_ _-- - --Water Supply: Public System and name----------------- -----------------------------------------; 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 /> p „dowing size of lot, location of system in relation to wells, buildings, etc. mutt be.raced on reverse side-)' <br /> (Plat Ian, <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] <br /> F PACKAGE`TREATMENT [ ] SEPTIC TANK Size:____' -� stX ---------------------___-Lfqutd Depth-_Z____-_ <br /> Ca acit 4______- -T °.-__--� Material_ -_No. Com artments.-------- - -- <br /> .Foundation a ----- <br /> Distance to nearest: Well___ _ ____ _________ ____________ _ -Pro Line-_ <br /> LEACHING LINE No. of Lynes_ -----______.Length of each liner- - _ _To#alrength ,� . D <br /> �j .. <br /> 'D' BoTypeFilter Material - - Depth Filter Material -----­------------ <br /> x--- a <br /> Distance tQ nearest: Well---J-24----------------Foundation___AA1-------- ----.Property Line ----------•- <br /> SEEPAGE PIT QQ� Depth- _____Diameter_-4 --�-- ----Number-------A______ ___ ________ Rock Filled Yes (' No❑ f- <br /> Water Tablo Depth.- ---/4:014- <br /> ---- Rock Size <br /> Distance to nearest:Well--- _--_. _-_-_--_--_-foundation-__-er�. -_-_ -_--Prop, Line-- o ::_ .r_ <br /> REPAIR/ADDITION(Prev. Sanitation Permit#----------------------------------------------------Date- --_--_---- ------- ----------------------- <br /> Septic <br /> -- --- --- -Septic Tank (Specify Requirements)----- --- ----- ------- ---------------- --------------------------------------------------- <br /> Dispo al Field (Specify Requirements). ----- ---- ----------------- - -- _ <br /> �i D -- - -- ----- ---- - - ------ <br /> (Draw existing and required addition on reverse side) <br /> Mme ` <br /> 1 hereby certify that 1 have prepared this application and that the work will be done in accordance- with San Joaquin County . <br /> Ordinances, State Laws, and Rul",prid``Itegulations of the San Joaquin,Local Health District. Home owner or licensed agents <br /> 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 ers <br /> to beco b" t to Workman's mpensation laws of California." <br /> Signed ------ `------ -- ---Owner <br /> By................... -- ----- 44 <br /> Title <br /> (If other than owner) <br /> EPABTM T USE 9NLY <br /> APPLICATION ACCEPTED BY--- -----------------------------------------------DATE -------- - -l� ---- -- =-' - <br /> DIVISIONOF LAND-NUMBER----------------------------------- --------------- ---­-------------------- ------------:DATE---- '---- --------------------- --------- <br /> ADDITIONAL <br /> ----- <br /> ADDITIONAL COMMMENTS---- --- ---------------4--------------I- ------------- ----- -----------_----•---- ------------ ------ <br /> 1ai� -` . ------- �- --- --------------------------------------------- - -- - --_------- ---------- --- - - - - -- - - _ <br /> ------------------------ •---------------------- --- <br /> Final Inspection by_ - -- -Date ------ <br /> EH 13 24 "w_- 216 REV. 7/76 3M <br /> SAN JOAQUIN LOCAL HEALTH.DISTRICT - P ., <br />