Laserfiche WebLink
FOR OFFICE - APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. _72,---—- .� <br /> ---------=----------------------------------------------- <br /> This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> -------------_---___------_------------_---- ------- <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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .____------ _OLL6- _________Q�-----Sho_-Mf.----Qv---`---------------CENSUS TRACT _ - --------------- <br /> Owner's Name ------------------------- �if-----&-`U"s_1 ------------------------------------------------------------------Phone --------------------------••------ <br /> Address ---------------------------------------S 1A,----------------------------------------- ------------ City <br /> Name ---------------------------------------------License # ----'---- --------------,Phone ----------------------._----- <br /> f <br /> Installation will serve: Residence ❑ Apartment House-[] Commercial :❑Trailer Court ;❑ <br /> Motel ❑Other _ -___.________ <br /> Number of living units_____________ Number of bedrooms z-------Garbage Grinder ------------ Lot Size ____i4 - -_______--__- <br /> Water Supply: Public System and name --------------------------------- --------------------------------------- ------------------------------------Private [ — <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam []/"Clay Loam ❑ <br /> Hardpan ❑ AdobeFill Material _.____._____ If yes,type __-______j_______._________ <br /> (Plot plan, showing size of lot, location of system. in relation tto,,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,) 0 <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'1*Tj Size---:__0_ ___ --V-________________ Liquid Depth �t--____....,.____ <br /> Capacity Type p ---------- <br /> - <br /> T e ��____ Material No. Compartments ____��._..._.._ <br /> Distance to nearest: Wel) ---- jw- - ----------------Foundation --- ------------- Prop. Line --- ®------------ <br /> LEACHING LINE [ ] No. of.Lines --- ---------- Length of each line------ --------------- Total Length __ b --------------- <br /> fil <br /> - <br /> pl"L'- <br /> D' Box I---- Type Filter Material __ -___Depth Filter Material --------------------_---------------_....... <br /> - <br /> Distance to nearest: Well --- ------------ Foundation __�f---- -- Property Line .-__ ........... <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------._..... Number ___________________________ Rock Filled Yes 0 No 0 <br /> Water Table Depth --------------------- -------•-----------------Rock Size -------------------------------- <br /> Distance to nearest: Well -----------------------------------------Foundation -------------------- Prop. Line -----------..-......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------- ---------------------------- Date ----------------------------------) <br /> SepticTank {Specify Requirements) ---------------------------- ------------------------------------------------------ ----------------------..__.---------------------------- <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------- ------------------------------- ---------- <br /> -------.---------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------ -------------------- <br /> ---------------------- (Draw existing and required addition <br /> ---------- <br /> --------------------- ----------------- ----- --------- - ------- <br /> dition an 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: 0 <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 becom sublet to Workman' Co ensation laws of California." }f <br /> Signe.-- ----------------------------------- Owner <br /> BY------------ --------------------------------------------------------------------------------------- -Title --- --------------- <br /> ------------------------------ <br /> (If other than owner) <br /> FOR DEPART T S ONL1C <br /> r <br /> APPLICATION ACCEPTED BY _--------------------------- ------ DATE --- --- . ;T� ----------------- <br /> BUILDING PERMIT ISSUED ------------------------------------- ---- ---- ------- -------DATE ..-- ----------------------- <br /> ADDITIONALCOMMENTS ------------------ --------------------------------------------------------- ----------------------------------------------------- --------------------------- <br /> - ------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------- -------------------------------------- ' ------------------------------------------------------------- <br /> ---- <br /> FinalInspection by: ------------------------------------------------------------------------------------------ ---- --- -----.Date `j <br />