Laserfiche WebLink
[ FOR OFFICE USE: �y�f � <br /> AF`�LICAION FOR SANITATION PERMIT <br /> ------------------------------------ Permit No. <br /> ------�---�--�---------------- (Complete in Triplicate) - -•••� ' <br /> �0------------------------- <br /> - - d <br /> c; -I/ ------------------------------- This Permit Expires 1 Year From Date Issued <br /> _.--_.--__-_-_ <br /> 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 existing Rules and Regulations: <br /> f JOB ADDRESS/LOCATION --------------- - -- CENSUS TRACT ----- -------------- <br /> ------------ <br />` Owners Name -nn_-- - <br /> j t .�•a ------------------------------------------.R ` Phone -.��q-� D <br /> ' <br /> Address , -------------------------- City ----------------------------------------------------------- <br /> Contractor's Name _ L" ►'-------------------------------------------------------------- ----------License # ---------:-------------- Phone ------------------------------ <br /> Installation will serve: Residence [Apartment House°❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other -------------------------------------------- <br /> }}�� � <br /> Number of living units:------------ Number of bedrooms ___Y----Garbage Grinder -__!ice4___ Lot Size ________________________ d <br /> Water Supply: Public System and name -----------------------------------------------------------------------•---------------------------------------Private s <br /> A ! <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat El Sandy Loam .E] Clay Loam�] <br /> ' <br />: HardpanAdobe ❑ 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.) I <br /> r NEW INSTALLATION: (No septic tank or seepage pit permitted if public.fewer 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 { ] 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 [ J Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No <br /> i Water Table Depth --------------------------------------- --------Rock Size -------------------------------- <br /> Distance <br /> -----------------------------Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) <br /> j Septic Tonk (Specify Requirements) ---------------------------------------------------------------------------------------- -;�--------------------------- <br /> Disposal Field (specify Requirements} ___` _ r .. __ _ _ __ f Ali,-"_______________��-- <br /> ---------------------------------s-----------------------------------------------------------------------•-----------------------------------------------------------------------_------------------------ <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 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 become subject to Workman's Compensation laws of California." <br /> NA'aSigned _ � _ _`.___- � _ Owner <br /> BY --------------------------- __ Title ------------------- <br /> ------------------------------------------------------------ - <br /> (If other than owner) <br /> FOR .DEPARTMENT USE ONLY <br /> r APPLICATION ACCEPTED BY DATE 1f7-`l��jr'--------------- <br /> BUILDING PERMIT ISSUED ----------------------- --------------------------- <br /> --------------------------------= - - <br /> ---------------------DATE ----------- - ------------------------••--- <br /> - <br /> ADDITIONAL COMMENTS ------------------------------------------ --------------------------- ------------------------ ------------------•---------------- <br /> r ----------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- ---- <br /> t --------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ <br /> I <br /> - - - - - ---------- <br /> Final Inspection by: . `' �� - --------- - -------------- ----------------------------- <br /> --------- ----------------------------------------- Dafie �� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br />