Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
r FIR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> o <br /> .......f.�. .. ....6.......................... Permit No.2 <br />,.....'.. � (Complete inTriplicate) ...�;;. .....`.'. <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 per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance N . 549 and existing Rules and Regulations, <br /> JOB ADDRESS/LOCATION �0 <br /> ..... .....�. ..r... ... ........ .s�. 6.Z&SVS TRACT .. <br /> Owner's Name .... .. . . ................. ... .......... Phone .... <br /> Address ... .. .................... city .. ........... .................... <br /> Contractor's Name ... :. �., .. t. . tj.icen:e # cr�`,G'.?'/..,�1`rl Phone �z <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court C] <br /> Motel ❑Other ............................................ <br /> Number of living units:.... ... Number of be rooms ........Garbage Grinder Lot Size .. s�. ' ..1 ..••. <br /> .... <br /> Water Supply: Public System and name .. . . s`.......e,-kj�.._....................................................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam a <br /> Hardpan ❑ Adobe 9 Fill Moterlal ............ 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.) 0 <br /> NEW INSTALLATIONt (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) (� <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I j 5fze........................... .......... Liquid Depth <br /> Capacity .................... Type .................... Material...................... No. Compartments ..................... <br /> Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE W No. of lines ....., ............. Length of each line.....0:. Cf.......... Total Length ... ......... <br /> 'D' Box ...;09"Type Filter Material _.a t. ....Depth Filter Materia) ......................... <br /> ,. .. <br /> Distance to nearest: Well . .C�� Foundation ...�Q.. ........ Property. : line .�$.................... <br /> SEEPAGE PIT j Depth a2..S..:. ... Diameter Number .....41................. Rock Filled Yes a No i❑ <br /> Water Table Depth ..... ....5Z7..... ....... ...........Rock Size ...��'!.....`................. <br /> Distance to nearest: Well .. .fes ..........Foundation Z.4.r........ Prop. Line .t4.............. <br /> REPAIR/ADDITION(Prov. Sanitation'Permit# ................•...•....•..•.•....•......•. Date ..................................) <br /> Septic Tank (Specify Requirements) .................. ........ ......................................... ........ ..._................. <br /> Disposal Field (Specify Requirements) ... � f .... .. ^4 ....................... <br /> ................................ .......... r-C._........... .. .1 .... <br /> ........................................................................................................................................................................................ <br /> (Draw existing and required addition an 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 Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the followings <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 /> Signed ....... ........................ ...................... Owner <br /> By ............... ..... .................. Title ....... ....................... <br /> (If other than owner <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. <br /> ............................................................................................ DATE .........;� �...�3............... <br /> . . <br /> BUILDINGPERMIT ISSUED ....... .............................................................................................DATE ..........................:................ <br /> ADDITIONALCOMMENTS .................................................................._............................................................... ........................... <br /> .......................................................................................................................................................................................................... <br /> : :::................... . .... ..........................................................................................,..:::::::: : . ....y3.................... <br /> FinalInspection by: . .........................................................................................Date ......... ....... .......................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> cdo <br /> E. H.13 241•'68 Rev. 5M 7/72 3 M <br />