Laserfiche WebLink
FOR OFFICE USE APPLICATION FOR SANITATION PERMIT <br /> -- ------ -- -- ----- <br /> ----- ------- Permit No. <br /> (Complete in Triplicate) <br /> ---------------- ------- - - - 0 <br /> 1h � 6 <br /> --------------- ---- -------------- IX- This Permit Expires 1 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 hereir <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIO ...... ------- <br /> --------------- <br /> ---------------------------- <br /> --CENSUS TRACT ....67 - <br /> ....... .............. <br /> Owner's Name ------------- ----------- -7 <br /> ------------------Phone sAlk; <br /> .:7n W <br /> --- ----------------------------------------- . ............ <br /> Address ---------------- ----------- ----- License <br /> City --------------------------------- ---------- <br /> -5�0 7 <br /> --- - -- - -- ------ -- ----- Phone .................... <br /> Contractor's Name -------- �OA­&---- ------------------------ --------License #/ <br /> Installation will serve: Residence %Apartment House-[] Commercial :[-]Trailer Court 0 <br /> Motel M Other ------------------ ......................... <br /> Number of living units:----- ---- Number <br /> ber of bedrooms _-_':__Garbage! Grinder ---_________ Lot Size ---c-P..X ................. <br /> Water Supply: Public System and name --------_------- -------------------------------------.....................................................Private <br /> Character of soil to a depth of 3 feet: Sand'[] Silt 0 Clay E] Peat M Sandy Loam {-] Clay Loam,0 <br /> Hardpan E] Adobe?5 Fill M6terial ------------ 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 iIs available within 200 feet) <br /> PACKAGE TREATMENT SEPTIC TANK S ji-io_ e-------- ------- -----------. Liquid Depth ........... <br /> Capacity/2----- Type Material_( t No. Compartments <br /> Distance to nearest: Well ----VqR_A/---------------------_Foundation --------I---- Prop. Line __Ja....... ........ <br /> LEACHING LINE No. of Lines ---------_I_-________ Lengthf ch line_---/00--e----------- Total Length ----------- <br /> 'D' Box __0------ Type Filter Material 0 <br /> ......Q............Depth Filter Material _____4-__ _ ________________________ <br /> Distance to nearest: Well .. ...... Foundation ---JO-f----------- Property Line ___ ........ <br /> SEEPAGE PIT Depth ---- 1----- Diameter Number ------/- -- <br /> ----------- ---- - Rock Filled Yes)< No. C] 37 <br /> I/ 00F <br /> Water Table Depth -----------------------------------------Rock Size <br /> Distance to nearest: Well ----- ..................Foundation .,_J_!P_" Prop. Linv-­_�.............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------- -------------------------------- Date ----------_____-_--___-__-_-•_,__) �' <br /> Septic <br /> --------------------- <br /> SepticTank (Specify Requirements) -------------- ------------- -----------------------------------------I------------- ------------------- .......... ...... ......__......... <br /> Disposal Field (Specify Requirements) ------------------------------------------------- ---------------------------------------------------------I-----------­--------------- <br /> ----------------------------------------------------------- ----------------------------------------------------------- ------------------------------------­--I- <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 Son 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 --------- --=----- --- --------- Owner <br /> ----------------------------------- <br /> By ------- - ---- - ----I - ------------------------------------------------------------- Title ----------ct--------------------------------------------------- <br /> (If o er than owner) <br /> E/AtTMENT U_5k ONLY <br /> APPLICATION ACCEPTED BY ------- --------6r- t------ -----. DATE ................. <br /> BUILDING PERMIT ISSUED -------------------------------- -------------------------/-------------------------------- --------- _DATE ---­---------- ...... <br /> ADDITIONALCOMMENTS -------------------------------------------__-------------------------------------------------------------------------- --------------_-----------_---- <br /> -------------------------------------------------------- ----------------------------------- ---------------­- ----------------------------------------- - <br /> ----------------------------------------------- <br /> ------------ ---------------------- ------ ---------- --- ------ ---------------------------------------------------------------------------------I........................................... <br /> --------------------------------- - ----------- -------: ---- - <br /> -------------I---------------------------------- ------ <br /> Final Inspection by: ----- ...... ---------��- ---- - �o ----- --------- -----------Date ---- - - ------ <br /> SAN. JdAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />