Laserfiche WebLink
FOR OFFICE USE: I FOR OFFICE USE: <br /> II APPLICATION FOR SANITATION PERMIT <br /> iI (Complete in Triplicate) Permit <br /> i.... Date Issued.,10_-3-.2e <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. t <br /> This application is made cam liance with County Ordnance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION.--- �ht! `^'r.._` I�`r'p`�L'" CENSUS TRACT--------'--'---'................ <br /> Owner's Name. .k........ ...... ------ . ----•-.' <br /> p� -'--------------------" '- -----------------Phone............- ...... <br /> Address-_.... _' <br /> ---- City..... zip....................... <br /> ....... <br /> Contractor's Name---- ----11-?M_,__- -­-- License #----------- ---------Phone_-..---:._..---------------------- <br /> Installation <br /> ------Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ t <br /> Motel ❑ Other........"" ....... ---- ---_----------------- <br /> Number of living units:..._"-" ----."_'l�umber of bedrooms..-... Garbage Grinder-.-.....:...Lot Size.V-.D..'7._�. . ...-.._----:-....-.:.... _. F <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 /> „Hardpar� ❑ Adobe ❑ Fill Material .. ....If yes, type......... - --- ....._. ._. � .—..�— # <br /> {Plot plan, showing size of lot, lavation 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,) ��// �1 <br /> PACKAGE TREATMENT_[] SEPTIC TANK ( �] Size -- M X ,� _ Liquid Depth..-.../..................�� <br /> Capacity-.mQ_t!------Type'_" __..-. ._....Material.'/1._- -..,, No. Compartments..-.-A <br /> --- <br /> Distanceto n.e.arest: Well------- _ :Q . .Foundation_...-. -. .... Prop. Line..."...................... a <br /> LEACHING LINE .""`.'---"-.......Length of -------------- <br /> [ ] Na, of Lines: .-.Total Length -. f. --.: <br /> Bax...:. - -Type Filter Material....".._1��._.Depth Filter Material...I.-7............................- - --- .-------. <br /> I <br /> Distance.jFWell-16-7-17i <br /> to nearest: .. .._.Foundation------------------ ---Property Line_....- �._............_.......-- I <br /> SEEPAGE PIT [ ] Depth---#A8.T.-Diameter------ ._13------Number......r)--------------------- ock Filled Yes No ❑ <br /> Water Table Depth."... • . . R ''T -.,.'.Rock <br /> Distance to nearest: Well----'--I-- `-Q----.---.--------.--Foundation/.17------------- - -- Prop. Line--------------.--'.---...... <br /> REPAIR/ADDITION (Prev. Sanitation Permit#-.- .- ---- Dafe:""".."..............'-.----..-.---.---..-'---) <br /> " <br /> Septic Tank (Specify Requirements)- _ --. _ -..--"- -_"---_'------ <br /> Disposal Field (Specify RequiremEnts)............ .......... ..-_ """------..------- <br /> •-------------------------"-" --------------- r -._....----- ------------------- ---------------`.----------- •------- -- -..........-- --- -.....---- -- . ---'."'.-----"-- <br /> .it � <br /> -------------------------•--------------- ------------------------------- ---------------__----------------------------------- ........ ......--'---....----...... ------ ------------ <br /> (Draw existing and required addition on reverse side) r <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State taws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: 1 <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 as <br /> to become subject to Workmanls Compensation laws of California," <br /> Signed---'---- ,� Owner <br /> 67 - �i <br /> By-------- <br /> (If other than owner) <br /> ... ' Title. <br /> .............................. ...........'-----...........__ ) <br /> ti <br /> OR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--.....11_.✓ .... ---' �" -: -- ---- �........ -. .... <br /> DIVISION OF LAND NUMBER.......................... .................DATE.....------------------- -" <br /> ------- ............. ........... .._.. <br /> .... <br /> -----------------------­ <br /> ................. <br /> ... <br /> ---------------------------------------------..... . ..... ------ ---------------- --&� - --- . Z ........ <br /> Final Inspection by:..." ..... ......................Date ) :: .... <br /> EH 13 24 SAIV JOAQUIN LOCAL HEALTH DISTRICT Fas 21677 REV. 7/76 3M <br />