Laserfiche WebLink
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
1-01 _ <br /> FOR OFFICE USE: g <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------- ---------------- Permit No. <br /> ,. (Complete in Triplicate) <br /> r;-------"---------------- --------------- <br /> Date Issued __.72___-,F- <br /> �_ - This Permit Expires 1 Year From 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 applii ation is made in compliance with County Ordinance No. 549 and e�Ixistin Rules and . eau ti ns: <br /> D it �¢[� (. �! - r- "------ ---------C� SUS TRAC; ------------------------- <br /> J A DESS/LOCATI �-- - -�- <br /> Owner's Name - l /'✓ ° - � . Phone <br /> Address ----- ---- City <br /> Contractor's Name f ------------------License ,. ,.���---- -----Phone - <br /> - <br /> Installation will serve: Residence partment House-E] Commercial ❑Trailer Court l❑ F <br /> 1 <br /> ❑ Oth <br /> Mate er <br /> Number of living units:--------1. Number of be ooms __ -_____Garbage Grinder �--------- Lot Size 4_"U---- ----------------- <br /> Water Supply: Public System+cgnd name _`_ -- __ Loc <br /> -- ------------------------- --------Private C1't <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam "❑ p - <br /> I Hardpan ❑ Adobe Fill Material _/ __ ifryes,type _-------------------------- u <br /> - 4 <br /> (Plot plan, showing size of Jot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> p see age pit permitted if public sewer is available within 200 feet',) <br /> NEW INSTALLATION: (No aseptic or <br />` PACKAGE TREATMENT [ ] SEPTIC TANK �ze__- Liquid Depth _ ---.----- [�ti <br /> Ca acct <br /> J �Materia[�— No. Compartments ------•--- <br /> P Y - --------------- Type / <br /> i D' once"to nearest: Well ____-- -----------------FoundationAQ_/ Prop. Line ___-_____ <br /> No. of Lines __„ ------------_ Length of each line___ -� _ _ Total Length /�?-—------------ <br /> LEACHING LINE [ ) ., -- -5 <br /> D' Box __ Type <br /> "!Filter Material Depth Filter Material ____________________________________ .' <br /> I <br /> Distance4o nearest: Well ___ -_____----- Foundations_ _- Property Line J <br /> -- - ---------- <br /> SEEPAGE PIT [Depth ........... Diameter _ - yr_ Number ------ _ --------_ Rock Filled Yes iQ----No <br /> Water-Table),Depth ----- ----------------------------------Rock Size �Zf- ------------ <br /> Distance to nearest: Wel[ ---- _______.............Foundation ------ Prop. Line _-Y--------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------------ Date -------------•--------------------) <br /> f Septic Tank (Specify Requirements). _r------------______ ` <br />} Disposal :Field (Specify 'Requirements) ----------------------- ---------------------------� ----------- ------------------------------------------- --------- <br /> f _ ----- ---------------.-___-----__'---___------_-----_-----_-_----_-_---_-_----.__..--_--_--_-__ <br /> _____________________________._________________'_-..__:_.____.__-____----_-__--_----_ --___----_________ <br /> -`} (Draw existing and-required'addition on reverse side) <br /> I hereby certify that 1 have p—repared this application grid that theawork -will -be done in accordance with San Joaquin <br /> County Ordinances, State Laws, aInd Rules and Regufdtions 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 subject to Workman's Compensation laws.of California." <br /> - <br /> Signed -------------------- = ------------1 ' ------------------------------`------•------------- Owner <br /> -------------------------------------------- <br /> By ----" -------------------------------- U/ ------------ Title --------- <br /> .(If other than ow r)- <br /> FOR DEPARTMENT USE ONLY <br /> 11110 <br /> APPLICATION ACCEPTED BY ..----i j ------------------ ----------'---------------------- DATE . -7.�----------- <br /> BUILDING PERMIT ISSUED F DATE ----------------------------------- <br /> ADDITIONAL COMMENTS _ - • . ' f4 ' ---- - - - <br /> -- - �/ <br /> -- . ---------------------------------- ------------- ---- <br /> ------- <br /> Final Inspection by Date 7 <br /> x SAN JOAQUIN LOCAL HEALTHR DISTRICT <br /> E. H. 9 1-'68 Rev. 5M " <br />