Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. <br /> _ Date Issued <br /> ________________ --------- ----------------------------- This Permit Expires 1 Year From Date Issued <br /> Appl cation is hereby made to the San Joaquin Local Health District for -a permit to construct and install the work herein <br /> des.c ibed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB !ADDRESS/LOCATION . --,. L--------1�_---------- a --------------CENSUS TRACT ---------------------•.._. <br /> Owner's Name Phone <br /> .-- �� -- <br /> AddressT = �C-==-= ="------------ <br /> �$� ------ a/.oi � � Lnse # �O�?•�Gl Phone _T�/!! 8'f� <br /> Contractor's Nam ! p , <br /> s <br /> Installation-•will serve: ResidehEeXApartment House^❑ Commercialf❑Trailer Court-f-]�—� — - <br /> Motel ❑Other ----------------------------'--------------- <br /> Number of'.living units: -_ _-_-_ Number off�bedr000ms �__/ __...Garbage Grinder -...__-__--_ Lot Size __ ------------------- <br /> ---------------- <br /> _______________ <br /> Water Supply: Public System and name .4i_ If',----[+V f ----------------_------------.--------_------- •_-f--.` -----Private ❑ <br /> I ' It <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy,Loam'bE,aClay Loam ❑ <br /> } Hardpan ❑ Adobe;K Fill Material ------------ Ifye"s,-ti type. <br /> s- i {rte <br /> (Plot plan, tshowing size-of lot;location-of-system-•in relation to wells, buildings, etc;must be placed on reverse side.) <br /> ik) <br /> NEW INSTALLATION:, (No septic tank or seepage p t permitted if public sewer is avdlable within 200 feet,) ` <br /> PACKAGE TREATMENT ( ] SEPTIC TANK'f ] Size__ � .t �------------------------- Liquid Depth --477e----V <br /> {v <br /> OQ t - -- _ ._t-I r <br /> Capacity _� .___.___.__ Type _________ Material .V-- -'""'No. Compartment f.._ <br /> Distance to nearest: Well -_ ----t.___._ ____-� ___-!-Foundation ---------------------- Prop.�L1n --------------•,•?•-- <br /> L_EACHING`LINE [ ] No. of Lines --------1------------- :Length -6f each line-140 --- Total Lend#)Y�� 7--_-.__.--,^-- <br /> { .... Type Filter Material- __ _Q� 3De th,��ter,�Material .1 _'. <br /> [ 'D' Box ---AS yp /� - p _ <br /> I Distance to nearest: Well _ a_ �_ __.�Fourfdation _-___-_ r ___-__, -_ Property Line .::_.:�----------------- <br /> - <br /> -SEEPAGE PIT [ ] Depth __ �___.__ Diameter SJr-�r-_ Number .._-_-_m.._ t° _ Rock Filled Yes No i❑ <br /> Water Table Depth -------------- x'------------------------Rock Size!...# <br /> Distance to nearest: Well -_--_. ____�� Foundation .------------�__�. rop. Line ------................ <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ____________________________________________ Date ---------------------------------_) <br /> Septic Tank (Specify Requirements) ------------------------- ----------------------- --------------------------•--------------------- ----------------•---------- <br /> Disposal Field (Specify-Requirements) __-_______ / _-._.-_..._ <br /> ------------------------- --- `` �------ ', -----------------------------------------------------------------I------------------------ <br /> -------- ------------------------ ---- <br /> ---------- ------------ ------------------------------------------------------------------------------------------- <br /> �. {Draary existing anA required addition on reverse side) <br /> I her by certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> Coun Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed gents 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 tobeconie subject to Workman's Compensation laws of California." <br /> Signe - --------------------- ------ Owner <br /> BY --- ----- - - ---------- <br /> ------ -Title ._ ------------ ---------------------- <br /> Iif other than owner) <br /> , FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------- ------- —------------------- ----------------------------------- DATE -------------------------------------- <br /> BUILDING PERMIT ISSUED ------------------- ----------------------DATE --------------------- <br /> ADDItIONALCOMMENTS - ---- ---------- - --------------------- -------------------------------------------- --------------------------- <br /> 1 <br /> - -------------------------------------------------------------------------- <br /> --- -- ------------------------------------------- ----------- ------------------------------------------ <br /> -- <br /> 1 <br /> ----- ----------------------------------- <br /> Final�Inspection by; Date .... r <br /> -- ----- ----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />