Laserfiche WebLink
FOR OFFICE USifs <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit <br /> ........................................ lComplele In Tripiicatel ..... <br /> ............................. .......... 7 <br /> ..... <br /> _ _ Dats Issued-:.�:�::.�.......� <br /> ....... This Permit Expires 1 Your From Doh 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 Ordinance No. 544 and existing Rules and Regulations: <br /> � JOBS-ADDRESS'AO TION ..---•h �,1-r.. .....".-CENSUS TRACTS=........................ <br /> � <br /> Owner's Nome .. •awNi '.._ lt. h. :....:.........._L.''.....................................Phone -..................._ <br /> Address . . ................I...........�.� �-................................................City .................................................................... <br /> :... <br /> Contractor's Name ....................... .....................................License # ........................ Phone .............................. <br /> installation will serves Residence;A' partment House❑ Commercial❑Trailer Court ❑ i <br /> Motel ❑Other .. .. ..... ...............•----•..... I <br /> Number of living units!..... --... Number of bedrooms .-- ______-Garbage Grinder ............ Lot Size ............................ ........ <br /> Water Supply: Public System and name ..........................................................:................................................Pr" <br /> � <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ day Loom ❑ 1 <br /> .i <br /> Hardpan Adobe❑ Fill Material y0s,type <br /> iplot 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,) fi <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] size................................................ Liquid Depth .............,..---y..--S, <br /> Capacity .................... Type .................... Material...................... No. Compartments ..................... <br /> ' Distance to nearest: Well Foundation...................... Prop. Line <br /> ,EACFIING LINE [ } No. of Lines ........................ Length of eachline............................ Total Length ..............,.............� <br /> 'D' Box ............ Type Filter Materia! ....................Depth Filter Materlal .......................................... <br /> - . Distance to nearest! Well ........................ Foundation ........................ Property Line ............ ... r; <br /> SEEPAGE PIT [ } Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No � l <br /> WaterTable Depth ................................................Rock Size ................................ W <br /> Distance to nearest: Well ......................Foundati .. .....-............... <br /> REPAIR/ADDITION 1Prev. Sanitation Permit# .....4 -V,�.................. Date � a.' .. `� ----•-•1..... Prop. Line <br /> Septic Tank (Specify Requirements) ................ ........................................ ........ .................... ........ ........ <br /> Disposal field (Specify Requirements) . . -.G ......11 . °.......-1.. ........:. <br /> r ............ <br /> ......... .. ............................................................-..............--=•-•• •-•--a <br /> )Draw,existing and required addition on reverse side) <br /> l t hereby certify that 1 have prepared this application and that the work will be done In accordance wills San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Herne owner or licorN <br /> sed agents signature certifies the following. I <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 Workman's Compensation laws of California." <br /> S:g`ned .........-................................................................................( Owner <br /> By ..... ............ ................... Title .-..........-....................-.................- <br /> pf other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> ............................................. DATE ....Y.... ../'�3..-........-_ <br /> APPLICATION ACCEPTED BY ...--...��.... -- .----._•--•••••••••••�• •- <br /> BUILDING PERMIT ISSUED ...... _. _ --- <br /> DAT .::: <br /> ADDITIONAL COMMENTS .. 7� � .. ... "-��.•-...��..:: . <br /> ......................................G? ..............................-..�.. .... ..-......--..... . . -..-----......:. ------ ..----- .............. ........ <br /> .............. <br /> Final Inspection b Date .....-.... -.�s _.?.1�------------- <br /> ' ER 13 24 1-611 Rev. 5M SAN JOAQU€N LOCAL HEALTH DISTRICT 8/7h 3M <br />