Laserfiche WebLink
" ^ FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------- -------------•-------- <br /> (Complete in TriplicatePermit No. <br /> _____-___________________________ _____________ This Permit Expires I Year From Date Issued Date Issued X., <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct a�n�d3insfalpthewrk herein <br /> described- This application is made in compliance with County Ordinance No. 549 and exists g Rul s a�e la 'ons., <br /> .JOB ADDRESS/LOCATION ---`-�y'K- --- ¢ tilkt+ rrENSUS T ACT -----------------•-------- <br /> Owner's Name III ------------ ----------------------- -----Phone - -� ------ <br /> h ---- ----- City ----------------------------------------- <br /> Address ------------------- ----- -- - - --- - - --------- -- -- <br /> Contractor's Name ____________ ___ ____ <br /> -- - ------ --1-- son"ea--m # 100011------ Phone <br /> Installation will serve: Residence ❑Apartmen ouse Commercial Trailer Court i❑ r <br /> Motes 0 Other - <br /> Number of living units------------ Number of bedrooms ------------Garbage Grinder ------ Lot Size <br /> Water Supply: Public System and name ---------------------------------------- ------------------------------•------------------------------•----Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ <br /> Peat—Sandy Loam Clay Loam <br /> Hardpan ❑ Adobe ❑ 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 ifipublic sewer is available within 200 feet,) j <br /> PACKAGE TREATMENT X SEPTIC TANK'[ ] Size ---`----- ------------------------ --- Liquid .Depth ---------------------.-_--- � <br /> Capacity -------------------- Type ----- ------ Material'_---------- -------- No. Compartments --------------.-.----- <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- <br /> LEACHING <br /> --------- ------LEACHING LINE [ ] No. of Lines --------- Length of each line--------- ----- Total Length ----------------- ---------- <br /> m 'D' Box'- --- Type Filter Material -------------- - -Depth Filter Material ----------•-------------------------- ...... <br /> Distance to nearest: Well ------------------------Foundation ------------------------ Property Line ------------------------ <br /> a _ <br /> SEEPAGE PIT [ ] Depth y-- ------ Diameter ----_ _-._----- Number ---------------------------- hock Fired Yes ❑ No i❑ 1� <br /> Water Table Depth ---- -------------------------------------------Rock Size ----------------------- -------- <br /> Distance to nearest: Well ----------------------------------------Foundation .------------------- Prop. Line ---------------------- <br /> 1EAWADDITI!ON(Prev. Sanitation Permit# -----------------------=--------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements).--------------------- -�-- --- ----------------- -------------------- ---- - <br /> Disposal Field (Specify Requirements) -------- AV1------ <br /> - - - <br /> cr' - -' 7 �L ----------------- <br /> ----------------------------------------------------- L -------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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: <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." o <br /> Signed -------- ------------ -- ----------- -- — Owner <br /> ---------------------------------------- <br /> ---- Title "---- ---------------- ------ ----------------------- r <br /> f of r han owner) <br /> FOR DEPAATMENr USE ONLY <br /> APPLICATION ACCEPTED BYE �, 1= - C:2�:- -------- DATE <br /> -------- ---------------- <br /> BUILDING PERMIT ISSUED -------------------------- -- -------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ------------------------- ---------------------------------------------------------------------------------------------------------------------------------- <br /> --------- ----------- --- -------------------- - ----------------- -------------------------------------------------------------------------------------------------------------- ---------------------- <br /> ----------------------------------------- -- ------------------- --------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------- -- ------------ <br /> - ---------- - ----- - - - - - - ---- - - - <br /> ----------------------------- - -------------------- ---- ------ - -- <br /> - -------------- <br /> Final Inspection by- - ----- -------------------- -------------- -----------------------Date -.-�-`Z- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT tr' # <br /> E. H. 9 1-'68 Rev. 5M <br />