Laserfiche WebLink
FOR OFFICE USE: I ( Z�_ 2oa-o7 <br /> APPLICATION FOR SANITATION PrRMIT 1 <br /> ------------- ----------------------------------------- Permit No. !� <br /> ---_--`--- <br /> (Complete in Triplicate) 4- <br /> Date Issued _--- <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 a work herein <br /> described. This application is in opli Je #h3C�ou�ty �Rdi nc 54 a d existing Rules d egul �ns <br /> s. <br /> - CENSUS TR <br /> JOB ADDRESS/LOCATION �------- - - <br /> ---1_�J-__- �,Q <br /> Owner's am - - -------- - �C ' - Phone <br /> Address C/ ' _____. Cit <br /> Contractor's Name --------61'% --- - -- --- -----------------------------------------.License # ----------- Phone ---------- ------------------ <br /> Installation will serve- Residence ❑ Ap tment use❑ Commer*l ❑Trailer Court 0 <br /> Motel Other - -------------7 <br /> Number of living units:.___-3__ Number of bedrooms ------------Garbage Grinder __�ff-d_- Lot Size -_ _ _------------------ <br /> Water Supply- Public System and name ----------------------------------------------------------------------------------------------------------- rivateX <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 __________________________ J <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 ---------------------- <br /> Distance to nearest: Well ------------------------------------Foundation ___ ----------------- Prop. Line ______________________ <br /> LEACHING LINE [ I 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 0 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) --2 ------------- ------- <br /> Disposal <br /> ------Dis osal Field (Specify Requirements)uirements) --- --------- ------- --- -- -- - - ----- -- ---------------------- ------- ------------- <br /> ----------------------------------- <br /> ------------ <br /> ---------------------------------- -----,------------------------ ----- - -------------------------------------------------------------- <br /> �\------------------------------ -- - -- - ---- ------ ------------ -------------------------------------------------------------- <br /> (Draw existing arO required a ition reverse side) l� <br /> 1 hereby certify that I 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, I shall not employ any person in such manner <br /> as to b come subje t to Workman's Compensation laws of California." <br /> Signe ---------------- ------- -- ------------------------------------------------------- ----- Owner <br /> B <br /> -'�'- <br /> Y --------------- -- ----------------------. Title ---- ---------------i--f <br /> S 'rn Qt <br /> (If other t ow <br /> FOR DEPARTMENT USE ONLY <br /> AP LICATION ACCEPTED BY ------------------- ------------------------- -----------. DATE -----'S- _1710---------------- <br /> BUILDINGPERMIT ISSUED ------------------------------------------------------------------------- --------------- --DATE ----------------------------- ------ (\ <br /> ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------------------------- --------- --------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- --------- <br /> ------------------------------------------- <br /> ----- - ----------------=------- <br /> Final Inspection by: --------�� --------------------- --------------------------------- ----- ------ -----------Date 7a------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />