Laserfiche WebLink
FOR OFFICE USE: _ <br /> ,p APPLICATION-EOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No: _ --- __------ . <br /> '------------------- ------------------ <br /> Date Issued _-_- �'- 9r� <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 <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> Q <br /> JOB ADDRESS/LOCATION bq- )- A� ' ASRA <br /> TCTj �'` <br /> ------ ..T_...... <br /> Owner's Name .. ��sf`•----------------------------------------- -------- ------.Phone ------------------------------------ <br /> 1 <br /> Address �� P�� - - �----------------------- City <br /> Contractor's Name ---------------------------------------------------------------=--------License # ----- --- ------ Phone ------------------------------ <br /> Installation will serve: Residence V Apartment House�❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑ Other -------------- ---------------------------- <br /> Number of living units:---- Number of bedrooms __ -________ g C7 �"+� <br /> Garba e Grinder _�.,�_ Lot Size ------------------------------------------- <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 /> Hardpan 0 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 if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT I ] SEPTIC TANK __16________________ _ Liquid Depth -:07--------------------- <br /> Capacity Type-Ad°-f_- Material_4`i_tr_yt�.+_____.__ No. Compartments a................. <br /> Distance to nearest: Well jol-Q9?�__------------------------Foundation _4Q.- ------------- Prop. Line Ar-_______-__-_ <br /> LEACHING LINE Al No. of Liin__e__s -A-_-_____.______.._ Length of <br /> each line__._------------ -_ Total Length „-,Q"__________________ <br /> 'D' Box ?%,-.- Type Filter Material Alr:----------Depth Filter Material !to----------------------------------- <br /> Distance to nearest: Well,41---------------- Foundation 2-D_----------------- Property Line r�__________________ <br /> SEEPAGE PIT Al Depth as--_'__________ Diameter 3-3---------- Number --.-.2— Rock Filled Yes ❑ No I❑ <br /> Water Table Depth -----------4a-67----------------------------Rock Size ----- -----��--------------- <br /> Distance to nearest: Wella "_, _ _ --q <br /> __--_ _____-___.__ <br /> _-.-Foundation�`°_S_. - -- Prop. Line f .______-_ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date __________._______________________) <br /> Septic Tank {Specify Requirements) -------------------- ----------------- ------------------ -----------------------------..-------- ------------------ <br /> Disposal Field (Specify Requirements) ---------- ----------------------------------------------------------------------------------------------------------•--------------- <br /> -------------------------------------------------------- ------------------------- - --------------------- ------------------------------------------------------------------ --- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I 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 lice <br /> n <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 beco s je to Workm n's Compensation laws of California." <br /> Signed _ --- _ OwneZLY By - ------------------------------------------------- --------- Title -- - <br /> (If other than owner) <br /> le FOR DEPARTMENT USE O <br /> APPLICATION ACCEPTED BYI---------------------------------- w-------------- -- DATE `/Mfr`-�------------------------- <br /> BUILDING PERMIT ISSUED -------------------------------------------------- -�'-------------------------DATE _...__.---------_-.---_ <br /> ----------------------- - <br /> -_, -------------------- <br /> ADDITIONALCOMMENTS -------------------------------------------------------------------- ---- ----------------- -------------------------------=--------------------------- <br /> -------------- ----------------------------------I--- -------------------------------------------------------- ----------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------- '----------------------------------------'r------------------------------------------------------------------------------------------- <br /> ------------------------------ <br /> ------------- <br /> - ------ ----=------- <br /> Final Inspection by: ___.____ _ -_.____.-Date _ -.--___- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />