Laserfiche WebLink
`FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> --- - Permit No. <br /> (Complete in Triplicate) <br /> -------- ---------------- ------- ----- <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 the work herein <br /> described. This application is made in compliance with County Ordinance <br /> No. 549 and existing Rules and Regulations: <br /> dey l/ /�n'1 CENSUS TRACT - � �.--------- <br /> JOB ADDRESS/LOCATION . /��``3' S' �----------------------- <br /> Owner's Name ------;.fit------- C�-Lc P.$�----------- ---------------------------------Phone ------ <br /> Address -----------------210/IT- .__. City �1 e - .�,qq <br /> Contractor's Name --------�.��r _ .`�- ------------------------------------License 4W92�______ Phone e23_'�s-X.- <br /> Installation will serve: Residence �tment House❑ Commercial ❑Trailer Court !❑ <br /> Motel ❑Other ------------------------------------------- <br /> Number of living units:------r---- Number of bedrooms __.....Garbage Grinder ------------ Lot Size A3a1 j;9_cK---------------- <br /> Water Supply: Public System and name ------------ --------------•----------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand' It❑ 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 /> 0 <br /> NEW INSTALLATION: (No septic tank or seep it permitted if public sewer is available within 200Lfeet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ Si e------------------------------------- - _ Liquid Depth ------ .......... W <br /> Capacity 1 to eej_______ Typ ____ Material�'i_1�1' r No. Compartments W <br /> istance to nearest: Well _,sff'O----------- ____________Foundation _Az--------------- Prop. Line _��____-__----_- <br /> LEACHING LINE [ No. of Lines ---,..3----------------- Length of each line----:VO----------------- Total Length __2.y ._ .......... <br /> 'D' Box 4P&---- Type Filter MateriagawywkDepth Filter Material _____ ....................... <br /> Distance to nearest: Well __cS(�_____________ Foundation _���_________ 8_ Property Line __.. l_.___......__ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter _______________ Number ..-----.-------------------- Rock Filled Yes ❑ No 0 <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) --------------------- --------------------.._--------------------------- <br /> DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- <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, 1 shall not employ any person in such manner <br /> as to become su ect to Wor n's Co ensat* n laws of California." <br /> Signed,. - ----------------------------------------------- Owner <br /> By -------------- ------------------------------------------------------------------------- Title --------------------------------------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---- -VC ------------------------------- ------ DATE ----- Z.------------ <br /> 'BUILDING PERMIT ISSUED _____________ DATE -------------------------._____-________.._ <br /> ADDITIONAL COMMENTS ---------- - ------------------- ------------------------------------------ ---- -------------------- - <br /> ------------------------------------- -------- ---- ---------- -- --------------- ----- <br /> 1 ------- -- ------------------- --- -- - -- - -- ----- ---------------------------------------------------- <br /> Finalr Inspectio ----- --- - Date <br /> SAN JOAQUIN LOCAL" HEALTH DISTRICT <br /> 'E.H: '' 1-'68 Rev. 5M <br />