Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />......... ._ _ _... ....:..._... . . . .7.-.�:.......... <br /> (Complete in Triplicate) Permit Na . <br /> 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 herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existinngg�/R1uule% and Regulations: <br /> JOB ADDRESS/LOCATION _ ._.............�Q/hG ie P16746.:1. .CENSUS TRRACTCT-..........•--•--... ...... <br /> Owner's Name . .._.. -.. . . . - fc�......:........................._..........__............Phone ..l .,� - ...... ...... <br /> Address ,l.0 Q-3. C ... -----------_.. City . <br /> Contractor's Name . -.�, �.. .., U G ------ _.. ---------__........License #,;�,?S ..._ Phone <br /> Installation will serve: ResidenceN Apartment House❑ Commercial [3frailer Court 0 <br /> Motel ❑Other _.. • . ........... •.................. > � <br /> Number of living units: l Number of b rams .......Garbage Grinder . Lot Size -___................._............ <br /> Water Supply: Public System and name . ._ C.cJ����.... ._.._.l. T......_.................._...Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam El <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 t ] Size... Liquid Depth .....�?.. . ........: <br /> Capacity lo'-7&-Q.. Type /V1C'c".CJS Material..._. No. Compartments ... .... ........ <br /> Distance to nearest: Well _.._.Foundation . Prop. Line ........ <br /> LEACHING LINE [ j No. of Lines a Length of each line fJ Total Length <br /> 'D' Box .. / T Filter Material si <br /> Type `,,��X.��Depth Filter Material ...---J.�................--...-----.....� <br /> Distance to nearest: Well ......... Foundation _. Property line ...._.................. <br /> SEEPAGE PIT [ j Depth _ _ Diameter ................ Number Rock Filled Yes, No <br /> Water Table Depth - -- - - ------- -•--.__.................Rock Size .... . ..............--........ <br /> Distance to nearest: Well ....... ..... . ..............Foundation . Prop. Line .................. <br /> "... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----- ..__ ... Date ..............:.......__.._-..._-) <br /> Septic Tank (Specify Requirements) ....... .................. ---•-----._.. .-....-................................ <br /> Disposal Field (Specify Requirements) -------------- ....... ._... .--.--.--._.... .............. <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 /> "1 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 sublec o_Workman's Compensation laws of California." <br /> Signed _ e Owner <br /> BY . _._ .. - Title <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY � %/- G'c.�-L� �"� _., DATE . <br /> BUILDING PERMIT ISSUED _ _..__ ._. . .._..__ ... . _ _ _.DATE <br /> ADDITIONAL COMMENTS .................. <br /> _ .................. . ....... ......... <br /> _. <br /> -----g... ..7V­ <br /> Final <br /> Final Inspection by: .......: Date . ... <br /> SAN J AQUIN:,LOCAL HEALTH DISTRICT <br /> .;f <br /> I3 24 <br /> E. H. 1-'68 Rev. SM 7/72:3 M <br />