Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------ ----------------------------------------- (complete in Triplicate) Permit No". <br /> -------------------------- ---------------- <br /> ti <br /> - ------------------------------------------ I-------------- This Permit Expires I Year From 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 application is made in compliance with County Ordina r nco No, 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIO ---- 757 `)5 <br /> ------------------ <br /> ----------- -- ------------------- --------------------.-CENSLIS TRACT -------------------------- <br /> Owner's Name -------------- -------------------------------------------------Phone ------------------------------------ <br /> Address 1677- -------- City ------4 4-__-Wl- <br /> ------- ------ --------------------------------- <br /> Contractor's Name ----------&_��_--------------- --- <br /> Installation will serve: Residence'[:]Apartment Hovse,E] Commercial [:]Trailer Court <br /> Motel [:]0 <br /> ther ----- <br /> Number of-living units:.---------- Number of bedrooms�:Garbage Grinder ---- ---- Lot Size <br /> Water-Supply: PublicSystem and name - --------------------------------------------------------------7----------------------------------•------------Private <br /> Character of soil to a depth of 3 feet. Sand;E] Silt:D Clay EJ Peat E]' Sandy Loam -E]. Clay Loam FJ <br /> Hardpan Adobe-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,) <br /> PACKAGE TREATMENT - SEPTIC TANK <br /> Sizer--- --_----------------------- Liquid Depth --__--7---_/ ----------- <br /> Capacity'W100-14-It Typec�-----------------l" 7 Material___":��---- No. Compartments- ------------------ <br /> If0%. <br /> istance to ne6rest: VVell ------------Foundation <br /> Prop. Line -------- --- <br /> -----------/-------- ., I <br /> LEACHING LINE No. tH <br /> �N hof -------/----------------Leng4 of each-'hne_____��__A ._�__Total-Lengtll --- ------- - ------------- <br /> 'D' Box ... ----- -- Type Filter Material ----------------Depth Filter Material ----1!��__.--`fie---.:._ .--- <br /> Distance <br /> - ---------- ---Distance to nearest: Well ---- <br /> Foundation Property Line I..------- <br /> SEEPAGE PIT 7ff--; 1+11 <br /> Dept Diameter Number ----/--------------- Rock Filled Yes�'N .,No <br /> Water Table Depth ------ - -------------- ______Rock'Size --- 3-- <br /> Prop. Line ..... <br /> Distance to,nearest: Well --------------le-0 -_--_-__Foundation ---- -- <br /> REPAIR/A6DITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- <br /> SepticTank (Specify Require.ments) ------------------------------------ ------------------=------------------ ------------- ------------- --------.----------------------------- <br /> Disposal <br /> -I--------------------------- <br /> Disposal Field (Specify Requirements) ------------------------------ ----------------- --------------------------=--------=------I.---------- ---------------- <br /> -----------------------------------------------------:---------------:------------------------------------------------------------------------------------------------------------- ---- ------------------- <br /> ii <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 w1lfh_'Sdh_jd-d`quTI "�- <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven. <br /> sed agents signature certifies the following: <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?Work7-7so pensatio ws. of California.'! <br /> Signed <br /> -------------------- ---- - -- ------ ------- --------- Owner <br /> ------------- <br /> BY ------- <br /> ------- ---- ---- -------- --- ---- ---- <br /> F other than owner) <br /> ........... - ------- Title <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- = ------------------------------------------------------------------------------ DATE --- 1-3-------------- <br /> BUILDIN6-PERMIT ISSUED - ------------------------------------------------------------------ ------ ---------------------------------DATE -- ---- ------------------------------------- <br /> ADDITiONA' --- <br /> L 'COMMENTS I <br /> ------------------------------------------------------------------------------------------------------------------------------------------ ----- ----- ------ <br /> ------------= ---------------------------------I----------------------- ------------------------------------------------------------------------------------------------------------------------ <br /> ---- -------------------------------------- <br /> -------------------- ------------I---------------------------------------- <br /> ----- ---- ----------- -------------------------------------------------------------------------------�7, ----------------- <br /> ----------------- ----------------- <br /> Final Inspection by: <br /> ------ - -----------------------------------------------------------------Date -------- ---------------- <br /> _ 4 <br /> ---------- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6B Rev. 5M <br />