Laserfiche WebLink
FOR OFFICE USE: <br /> f APPLICATION FOR SANITATION PERMIT . <br /> --------------------- ------------------------------ Permit No. <br /> (Complete in Triplicate) <br /> ---------- - - -- <br /> /j/ Date Issued .:_ <br /> --_________------------- --A..1.. --_--___________ This Permit Expires i Year From 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 /> JOB ADDRESS/LOCATION .-- .--!__ - - --- '-- L�,, �(1e --E!_c '----------------- -------------_CENSUS TRACT .- TY-7------------- <br /> Owner's Name , Phone. - -fa_IF__-_,3_______ <br /> _6#7 �/ <br /> Address �_ _ J•-'-A"�.,I�'.... City -------12.41ell-------------------------------------- ....... <br /> Contractor's Name ... --------------------------------------------------------------------License # --------- - ------------ Phone ----------------------_------ <br /> Installation will serve: Residence* Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other ------------------------------------------•- <br /> Number of living units:------------ Number of bedrooms ------------Garbage Grinder -------- ... Lot Size ----------._____---__--_------------------ <br /> WaterSupply: Public System and name -------------------------------------------------------------------------------- -------------------------------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 __________________ <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,) v` <br /> PACKAGE TREATMENT { ] SEPTIC TANK [ ] Size------------------------------------------------ Liquid Depth ---------.-----------.---_- <br /> Capacity --------------------- Type -------------------- Material--------------I------- No. Compartments <br /> Distance to nearest: Well ------------------------------------Foundation -------- ------------- Prop. Line --_--__-----_--------- �7 <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ___--___-_-__-__--_-_----- ` r <br /> } 'D' Box ------------ Type Filter Material --------------------Depth-Fitter Material -------------------------------------.-_-_-_ <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line _--_---_---_-___---___-_ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number -.----- -------------------- Rock Filled Yes ❑ No i❑ <br /> Water Table Depth ------------------------------------------------Rock Size ---------------------------••--- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _______ ------------------------------------ Date --_------__----_----_---_--.----.-) <br /> Se tic Tank (Specify Requirements) — <br /> Disposal Field (Specify Requirements) . �- <br /> r <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 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 beco subject to7o man's Compensation laws of California." <br /> Signed __ -.__ Owner <br /> --- -------------------------------- - <br /> BY - ----------------------------------------------------- Title ----------- ---- ---- ------------------------------------------------_ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------------------------------------- DATE <br /> BUILDINGPERMIT ISSUED -=------------------------- --------------------------------- --------------------------------------------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS ------------- ----------------------------------------------------- <br /> --------------- ------------------------------- -------- ------------ ------- ---- <br /> ------------------------------ ---------- <br /> - - -- ------------------------ --------------------------------------------------------------------------- <br /> Final Inspection by: ------- - --- - -- - ------ ---- - - -------------------------------- Date < ------------ <br /> 4 <br /> " SAN JOAQUIN LOCAL-HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />