Laserfiche WebLink
FOR OFFICE USE : -4 -L, - ­. - -- _ .- <br /> APPLICATION FbR SANITATION PERMIT <br /> i <br /> -----------------J---.------ -- (Complete in Triplicate) Permit No: _-_ ----_----• - -. <br /> 1 <br /> ---- ------------------ This Permit Expires 1 Year From bate 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. Thisa plication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB JLOCATION .__.h�I /�t� -- --------------------------CENSUS TRACT --------Own1,ADDRESS <br /> rs Name �}' sr• Phone <br /> ;nz-- - -------- --------- <br /> Address --- "7^.cnrT -------- City � ` <br /> Contractor's Name -p ... _ ! <br /> �r �� / -o- � os�_sr--. 1 Li:ense # . QdSll Phone - ' ' <br /> Installation will serve.A ResidenceXApartment'House,❑ Commercial :❑Trailer Court !❑ <br /> ". <br /> `� �MoteL�,Other��"�-�r__j_ �#'�_-_ <br /> Number of living units:"__ Numbertof_bedrooms____ `• 6' ` Q <br /> d f , �� ] ---.Garbage,Grinder—--------..-_Lgt_Size _- ---x---- ,j �----- <br /> x. ( pP Y [ Y Y i �✓ Pc.i.vate_r ! <br /> Writer Supply. System. and name _ _ __ _ <br /> Character of soil to a depth 3.feet:Sand' Sift _ clay y I ❑ <br /> .. . _ .. <br /> , ;, p ❑ Adobe Fill Material _-___- ---__ If as, t type ----- Clay Loam ❑ <br /> ❑ ❑ _Y_❑ Peat Sand Loam: <br /> t �. <br /> Hardpan Y� YP <br /> k ----------------- # <br /> r" t ' ':� <br /> [Ploplan, shawlg size of to!,,+location of system in relation to wells, buildings, etc, must be placed on reverse side.) <br /> IVEWj1NSTALLATION: f[No septic tank or seepag it permitted if public sewer is available within 200 feet,) 6\ <br /> PACKAGE TREATMENT r. ! ^" ' N <br /> [,]� SEPTIC TANK [ ] Size!---- ------�{',---- - --------- Liquid Depth _" '`�/__��..-------- � <br /> n q, , <br /> Capacity "/ Qa-- -- Type,_--- -----_ o,,Compartments ±. _-_ <br /> Materia!_-�._.--- _ No <br /> 1,� Distance to nearest; Well -_ _ "-_ --" --- ---_,Foundation �Q-------------- Prop. Line.. �..__.:.,•____. <br /> LEACHING LINE [ ] No. of Lines _ ------ CL th of each line___. �g �., I p <br /> ! t r g rS..« -- ------ Total Length erL -•-----•---- ' <br /> .` D' Box ._'��.- Type Filter erial __ @�---__Depth Filter Material _-.� �___--__________.- <br /> Distance toy nearest: Well -_____- --- _ _,r__-- Foundation <br /> l Property Line -______ <br /> SEEPAGE PIT i[ ) Depth ` a__-------- Diame r -------- Number ----------f__-__----:----_4 Rock Filled Yes No <br /> C I <br /> Water Table Depth -------- --=----• --------- Rock Size ------- <br /> Distance to nearest: Well ______ __ __________-__-----__-___--__Foundation _ _ 1 <br /> ------- <br /> Prop. Line ---------------------- <br /> p I <br /> REPAIR/ADDITION{Prev. Sanitation !Permit S# --__-__-__-_ � } <br /> Date ------•------••----•- ;------- <br /> Se tic Tank {Sp cify Requirement! <br /> ----------------- ----------------- <br /> Disposal Fie`ld_(Specify Requirements) ----------------------------- <br /> ---------- <br /> l ------- . <br /> - <br /> w {Draw existing and,-re wired ad <br /> I hereb certify that I have prepared this application and that the <br /> on reverse side) F <br /> y y e work will be done in' accordance with San Joaquin <br /> County Ordinance's, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the foliowtng: <br /> "I certify that I n the performance of 4he work for which this permit is issued, I shall note ploy any person in such manner <br /> as to become subiect to Workman's Compeniati.on laws of California." <br /> Si ne- <br /> g ---------- ---- -------- ---- ---------- Owner <br /> ByY - ------------------- <br /> --------- Title <br /> [G other than owner) --------------------------------------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION rACCEPTED BY 3 <br /> ING PERNII7, ISSUED <br /> ---- -- <br /> -- - ------- ------ ------------ -- DATE S'- '- �- <br /> ADDITIONAL COMMENTS ._.------------------------ <br /> -------------------------------------- <br /> ----------------- --------------DATE ------------ <br /> ------------- <br /> ------------- <br /> --------------- - ------------------------------------------------------------------------------------------------------------------------------------------------ ----- <br /> 1 t t------- <br /> Final`Ins ection by': ----c1'---]6 - ----------------------------------- --- <br /> --- -- --- ------------------------------------------------------ --------------- <br /> ------------------- --- <br /> - - <br /> Date <br /> N JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H 9 1-'68 Rev. 5M <br />