Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT <br /> . : ...... . ............... <br /> (Complete In Triplicate) Permit No. ..................... <br /> ......... .. <br /> �I .... ...................................... P - Dae Issued . 2-,.3&7/ <br /> ••••• .: This Permit Expires T Year From Date Issued t � <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 C my Ordina No, 549 and existing Rules and Regulatlonso <br /> II .i <br /> �� JOB ADDRESS/LOCATIO CENSUS TRACT ................ <br /> I� Owners Name m.../`/ . .. ..... ..................:.................. <br /> ......�.....................- Phone <br /> Address .`; _ : .. ........ City ~......:...... ' ... <br /> i; Contractor's Name . . . r- - ........................................License # . _ hone 6. <br /> ` it Installation will serve: Re 041-o'"ment House 0 Commercial ❑Trailer Court �] � <br /> ! it Motel❑Other..- .................................. ". <br /> o . <br /> Number of living units..- •-_---- Number of bedrooms ,.;.-... .� <br /> ._r'�::.....Garbage Grinder _...... .... Lot Sizer :..-•.-----....... � ...:.-•---........ <br /> Supply:upply Public System and name Private <br /> ' <br /> Character of soil to a de th of 3 feet: Sand Silt Cla " s <br /> p ., ❑ ❑ Y ❑ Peat❑ Sandy Loam ❑ ClayLoam" <br /> ��] <br /> F Hardpan❑ Adobe❑ Fill Material ............ if es <br /> ij y ,type..... <br /> .......... ...... <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc, must be placed on' reverse ilde.). <br /> NEW INSTALLATION*. - (No septic tank or seepage pit permitted If.public sewer is available within 200 feet,) <br /> r PACKAGE.TREATMENT• I"] SEPTIC TANK f�I Size._.. Liquid Depth ` ' <br /> II Capacity • �y` '� Material....................... No. Compartments enty..... : . <br /> -40- - <br /> li Distance to nearest: Well' .. ���.........................Foundation � �...... ... Prop. Line <br /> .. �_1...._.....:� <br /> ii LEACHING LINE [ j No. of Lines -- __.-_---_4... Length of ch line............................ Total Length ..:........,.-------•....... <br /> i` 'D' Box ./.------ Type Filter Material ....Depth Filter Material. ...1._`........................ <br /> Distance to nearest: Well ................I._...... oundation ....................:... Property Line ..............:....... <br /> SEEPAGE G�E PIT [ I Depth ..... Diameter Number . <br /> - ••-------s----• .......:........ ................-•-•------._ Rock Filled Yes ❑ No [� <br /> Water Table Depth ................................................Rock Size <br /> t <br /> i' Distance to nearesh Well ....................:,•!.............. Foundation Prop. Line <br /> REPAIR/ADDITION 1Prev. Sanitation Permit#` __."- ',--:�•__--I <br /> Date ..--•---•................. •I <br /> Septic Tank (Specify Requirements) <br /> .............. <br /> _�f•• <br /> C�. -- ....:._- � `:: . : : ::j Disposal Field (Specify;RequiremenTs : : ..:. <br /> .............................................::: '. . _- ___................ . .*::......................... . ........ ...............4. <br /> ... .. ....:.... :. .::::::::::::::..........:....................... <br /> . 1 <br /> (Draw existing and requiredaddition on reverse side)----- 79, <br /> I hereby certify that I hale prepared this applicatior�i and`that,the work will be done in accordance with San Joequl <br /> County Ordinances, State Laws, and Rules and Regulations'of,the San Jonquin I.acal Heotth-District:Herrn* owner or Ilcen•0 <br /> sed agents signature certifies the following: <br /> K "I certify that In the performance of the weark{for rhich this-pe:enit-is'issued, I shall.not employ any person in such mannee� <br /> as to becoen subject to War an's Co ensallon laws of Californla." _ r v <br /> Signed ... f. . .........•----- ....-- ..'Owner <br /> i <br /> B . r <br /> Y ...:......... ...............I... ................... :....:..... . ............----- <br /> Title . <br /> ...............:..........: <br /> (IF other than owner) <br /> yi FOUR DEPARTMENT USE ONLY r <br /> APPLICATION ACCEPTED By . �,�r.T7 <br /> .......................................... <br /> •..........................•-•-- .....,.DATE .:/�:;-........:.................. ' <br /> BUILDING PERMIT ISSUED' <br /> ...............................DATE .............:... <br /> ADDITIONALCOMMENTS ................... ........• .........•_...-................... - ._................-.......................-..................:......._......:.......... <br /> ............. .................... ..............-..............................................-...................................................I................ <br /> . <br /> ............................. ........ -------- .......... <br /> ............................. - <br /> ins nspettion by: ...... --............................ ..............Date .. ...-, -�..-...............--... <br /> Eft 13 24 1-48 Rev. 5l SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> J <br />