Laserfiche WebLink
N <br /> r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> _..y..........y.......................... ... <br /> (Complete in Triplicate) Permit No.�r/..— <br /> ' Date Issued.:1/:- .7,/.. <br /> +�...................... This Permit Expires 1 Year From Date Issued 7 <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/LOCATI r ... , _.. .... ........................................CENSUS TRACT .......................... <br /> Owner's Name ... ...C, .. . . ............... ....... .................................................... Phone .' �. .`6 7.... <br /> Address .......... <br /> ...............�?' . -;)-. .3. .... ....... .... City ... --..-.... .- .......................................... <br /> Contractor's Name ....... .............. ... ........................License # Phone .V�L�!V... <br /> Installation will serve: Residence X.Apartment House❑ Commercial ❑Traller Court 0 <br /> Motel ❑Other ............................................ <br /> Number of living units:---- Number of bedrooms ..:�.Garboge Gri r ............ Lot Size .....�� ....X 1p� .......... <br /> ... <br /> Water Supply: Public System and name ..... ....................................... <br /> - .......- ....._....................._.............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 ............................ w <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 r r �� `� <br /> ( � ... Liquid Depth ..��............. <br /> Capacity��G. ........ Type ..... Material..�%�!. No. Compartments <br /> Distance to nearest: Well ....................................Foundation ...... .fl........... Prop. Line ...�....�'...... <br /> LEACHING LINE T4 No. of Lines .........1............ Length of each line...... ......... Total Length -fes./............. <br /> 'D' Box ............ Type Filter Material ...Depth Filter Material .... t�.�............................ <br /> Distance to nearest: Well ........................ Fountlallan ...../*P.---......... Property line ... .................. <br /> SEEPAGE PIT Depth .Z1 f.._....__Diameter .. .�..... Number ........I................. Rock Filled Yes,� No i[] <br /> .................Rock Size A-.11. ..� <br /> Water Table Depth .............................. .11z........ � <br /> Distance to nearest: Well ........................................ ....e� ...r.... Prop. Line ..,5 .............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) <br /> Septic Tank (Specify Requirements( .............................. <br /> DisposalField (Specify Requirements) .......................•..............................•.........------....----.................---........................-•-•--••••- <br /> ••----•--------------------•--------.............. ............. •----••---......----•----•--........................------------................................----••-•-•--••...............•--......... <br /> ...................................................................................................._............................................................................................ <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application.and that the work will lie done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or licen- <br /> sed agents signature certifies the following: <br /> "1 certify that in the performance of the work for which this permit isIssued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ........ ...... <br /> ...•-- --- <br /> • - -- <br /> -----,---•----- <br /> ---........... Clwner <br /> .............••---................ Title ...................... <br /> By —.......... ... ................................................ <br /> .. .. ..... ... . . . ... <br /> ( oth t an owner) <br /> FOR DEPART NT USE ONLY/ <br /> APPLICATION ACCEPTED BY...... .. :.ei~ ce... DATE ...... ..C1.' .".. � .. <br /> BUILDING PERMIT ISSUED ......................'. %'........................DATE <br /> ADDITIONALCOMMENTS .................................................................._..,c':...............................:.........................:........................... <br /> ........................................................................................................... ..;. ...................................................................................... <br /> ............•-•-•...._....... .. `................ .`. ....--•---................................................................................ <br /> ........ ...... ....... <br /> .............................................................. <br /> ...... ...... <br /> Final Inspection by: a .......Date . .....`... ............. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 241•'68 Rev. 5M 7/723M <br />