Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ................................I....._. <br /> :.............................. .................... 2- (ComphNe in Triplicate) Permit No. ..,7 ... _S <br /> ................................................ ar This Permit Expires t YeFrom Date Issued 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 applicafion is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: <br /> JOB ADDRESS/L TION -4- , 0 <br /> rx�...._-../....-...••.................... N <br /> ..._._ - � ......Phone <br /> Owner' m .. __ 1xS �. . . . .. <br /> Address .4<? .......... 21 .. .........................City .� . . <br /> ....�.._.. <br /> .. <br /> Contractor's Name ......... ............................ enseZ, .eone <br /> Installation will serve: Residence Apartment House Commercial❑Troller Court <br /> Motel❑Other............................................ <br /> Number of living units:....../_-- Number of bedrooms .....2;-Garbage Grinder ............ Lot Size ............................................ <br /> Water Supply: Public System and name ..•--------•-•-•..............._.--•---............._..........._....---._.........--------..............Private <br /> Character of soil to a depth of 3 feet: Sand, Silt 0 Clay ❑ Peat❑ Sandy Loam 0 Clay Loam❑ <br /> Hardpan❑ Adobe❑ Fill M6twia!............If yes,hype............. . ............ <br /> (Plot pian, showing size of lot, location of system in notation to wells, buildings, oft. must be placed on rewrso side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 2W feet,} <br /> PACKAGE TREATMENT I J SEPTIC TANK f ] Size... ..................... Liquid Depth '� <br /> Capacity .................... Type ----- •------- Material. .....•-----..... No. Compartments .................... <br /> Distance to nearest: Well ................ ................. ounciation ........_............. Prop. Line ......................0 <br /> LEACHING LINE [ J No. of tines -------------------------- <br /> ..............•--.----- Lang of each 1 Total length ............................ <br /> 'D' Box ............ Type Filter Mate a) ........... ........Depth Filter Material ...............................•............ Vi <br /> Distance to nearest: Well ...... ndation <br /> ........ ......... ......._............_... Properly Lina ........................ <br /> SEEPAGE PIT O Depth ...... ............ Viame ._............ . Number ............................ Rock Filled Yes ❑ NoOP <br /> Water Table Depth ............ ........... .........Rock Size ................................ �. <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ........... .........'1 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# . Date <br /> Septic Tank (Specify Requirements) ....................J...... .............•.................................._............. ..................., ..._.................... <br /> .7 <br /> Disposal F' !d (Specify Requirements ... 1�. .._. lf.....! . .. -e s7. __.... ��`�..._ _..�.?.�irY.../ <br /> 5..� �.�- •--------- 1 , .. �.:P......_. ............................._.............,................... <br /> -------------------------------------------------------------------- ......................................._............................................................................................ <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that 1 have prepared this application and that the work will be done In accordance with Sal Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heald,.District. Henn owner or licen- <br /> sed agents signature certifies the fallowing: <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 became subject to Workman's Compensation laws of California." <br /> Signed -- •---•-------•---- Owner <br /> BY - ----------------•-•--•-••......•••--_. title ---------- ---........... .... <br /> (If other than owner) <br /> '­ <br /> DEPARTMENT,USE ONLY <br /> APPLICATION ACCEPTED BY ------- -. . ...... ... .. . ...... ........ �� <br /> BUILDING PERMIT ISSUED ..... .............. DATE . <br /> ----..----- ...........................................DATE ._....---------•-------------------------_. <br /> ADDITIONAL COMMENTS -----................ _. ..... •.._.. - ..........._.. <br /> .... .................._......_.....----- .........................-.............................._..........--- .-•--- .....................---.......-----.............. <br /> ................. ..... -- ----------------------------------- ....-.........-........-........I........................ <br /> ------ ...... ••••-- ••-•.. .......... ..• . ............. ........... ............ <br /> ... ...... <br /> Final Inspection by- ---- --------------------•---- ..... _ .. ........ ...... •. ........-............................:_...Dat..e .. .. ----� - -�J -----........----- <br />' EH 13 24 1-6.3 Rev. 5M SAN JOAQUIN L HEALTH DISTRICT 8/7h 3M <br />