Laserfiche WebLink
.d. <br /> FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------ <br /> (Complete in Triplicate)- Permit No........9.-.. ......r� <br /> ...................... <br /> `�- � �-------- -----•------ Date Issued�3'-.,A.T-9;9 <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 described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION------ ----- 1rd ..............CENSUS TRACT........... <br /> f�..- <br /> Owner's Name. --- ........ 1 -��.. .. •--- Phone- s .. <br /> ,r S <br /> Address._.-- - --�(�4 ----- --L�Q.�_�_�.�!�.--------�� . ..CitY--��9wTc�A- - ------ - . ZiP--� ���- --------- <br /> I�E, --------. .. .... _ ..S o2 -- Phone �7.'j"V� j-- <br /> Contractor's Name.. . ���_`�/...�U "' ..License � <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other-- - ------ ........ <br /> Number of living units:._._1....--....Number of bedroomA—E-_. Garbage Grinder---_ ......Lot Size.......1...... _ . - ...-....-_. ------._....- <br /> Water Supply: Public System and name___..............._.._.._--_-- . . . . . ..Private <br /> Character of soil to a depth of 3 feet: Sand [❑ Silt❑ Clay E] Peat E] Sandy Loam'° Clay Loam El <br /> Hardpan E] Ada <br /> 'be E] 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,) G— <br /> PACKAGE TREATMENT ( ] SEPTIC TANK [ ] Size------_ ...............__._._--------.-...__..---.----.Liquid Depth.__..--------- <br /> Capacity..-- ---- ------Type------- ---------._....Mate,rial-- -•---_- .No. Compartments------ _--------. ----------- <br /> Distance to nearest: Well..................... ....._`_...._..._...Foundation....-_.... . ........__ Prop. Line...._.......___ .._... <br /> LEACHING LINE [ j No. of Lines . ... .....................Length of each line... ----.------- -------------Total Length .__...-_---------...........___..'� <br /> 'D' Box----- --. ..Type Filter Material.^__:_ ......... Material---........_.._------------------ <br /> Distance to nearest: Well......................-----.Foundation ----- Property Line..........____._....-_-----------. <br /> SEEPAGE PIT [ ] Depth------- _...Diameter..------------ .....Number__.:---------------------------- Rock Filled Yes ❑ No Is <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 /> le rT . . Ic➢' <br /> Disposal Field (Specify Requirements) _...... .'.� � �a.��?_...--_.� X 5_,C ----- <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 County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: , <br /> "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become sub''t to o n's Cpmpensafion laws of California." <br /> Signed---- Ownex <br /> BY---------- - ----------------------------------------- ---- •----- -------- ....... Title--------..... ------ -------- --- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY Q <br /> APPLICATION ACCEPTED BY..... .._. <br /> - <br /> 'F - DATE --.. �— .. /.. <br /> DIVISION OF LAND NUMBER.------ ..... . ------DATE_---..... ----- - - -...-----... <br /> ADDITIONAL COMMENTS_.-... ------------------------------------------------- -----.___ .- ---... <br /> ------------------- -_.. . ----- -------- --..... ------- _.. ----------- ......... ................................................ <br /> ---------------------- •. ---------- --------------- ---------- --- -------- ----- ...---------- <br /> - ----- _ -- ---------- <br /> Final Inspection b � �� q <br /> Y:- ---- - - - -- --- ------•----•-----------•---------- --------------------• ------ ---------.Date--------•---�-- - -- - ----- <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas7 REV. 7/76 3M <br />