Laserfiche WebLink
,I <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------- -- -------------------------------- 7� 73 <br /> .. -•-• (Complete in Triplicate) Permit No. <br /> --- <br /> `.. - Date Issued .. "r?.=.7 . <br /> „ <br /> .............................._............... This Permit Expires 7 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 /> JOB AQDRESS/LOCATI N ..f_. ._._.._ .. ._. . . _ _.................... CENSUS TRACT ....•._._..........__..._ <br /> -_-_- ._:_:_:.___ -- <br /> . .. ... - . -. <br /> Phone Owner's Name <br /> Address --• - --------- ----- ------ -•------ .... .....--•-- city . ........ ...... ........................ <br /> nse # PhoneContractor's Name . . _. � ce <br /> =I Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court - <br /> Motel ❑ Other ....._ C1 ---------------•_-. <br /> Number of living units:............ Number of bedrooms ............Garbage Grinder ------------ Lot Size .___,., ..._........ <br /> Water Supply: Public System and name ----------------- ----•--------------------------------- .................................. ---•---•---•......Private <br /> FCharacter of soil to a depth of 3 feet: Sand'❑ 'Silt❑ Clay ❑ Peat❑ Sandy Loom fl Clay Loam ❑ <br /> - Hardpan Adobe.C] Fill Material ............ If yes,type ---__-._.____._________.... <br /> FIPlot plan, showing size of lot, location ofsystem in relation to wells,.buildings, etc. must be.placed on. reverse side.) <br /> NEW INSTALLATION: (No septic tank or see ge pit permitted if ublic sewer is available within 200 feet,) <br /> ( ] � - ` ... q P --.V.......-•--- ------ <br /> PACKAGE TREATMENT SEPTIC TANK Size.. ._ '2 /tel __ . . Liquid Depth <br /> Fl Capacity _.. Type _- Material--- .--- No. Compartments ...................... <br /> Distance to nea( st: Well -------- •...............Foundation___�4Q__..__..._.. Prop. Line -..-, ----•-•_-_---. <br /> LEACHING LINE [ql No. of Lines .___r____ g p <br /> --------.... Length of ear.It line..___:...._:-.---•_-__-. Total Length. ....................,„j <br /> 'D' Box --.�--- Type Filter Material ......0.4......Depth Filter Material ._....✓!--".....:...................:... <br /> Distance to nearest: Well ....... Foundation .... ------------ Property Line ...........-__..... <br /> . ��.: Number ..._ Rack Filled Yes No <br /> SEEPAGE PIT [ Depth _...�.-•------..._ Diameter .__ _.....�-------------- � o ❑ <br /> Rack Size _.�.1/_.. �-"..--_.... <br /> Water Table Depth •-••--.. ...................• l _ <br /> Distance to nearest: Well -------- .............Foundation .-- Prop. Line -- ---------- <br /> ? REPAIR/ADDITION(Prev. Sanitation Permit# ------------------ _ Date -__._.________-_/_--_-- <br /> Septic Tank (Specify Requirements) ------- -••-•----•--•-•--------------------- ---------------_ -•--•.. --------------------------------- ------..._-•-------- i <br /> r 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 licen- <br /> FI sed agents signature certifies the following: <br /> "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> i <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .._......_._. ----------------------" _:.. f... •----• Owners. � <br /> I � <br /> s . .: ..... Title ` :... - .._:..... <br /> By ........ ............ other than owned .._.....: . ::.... .:. :....._..----•-•-- -_.. <br /> 4 FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------ ......... .......................................................................... DATE ....,..; ... 7-1.1.......... <br /> BUILDING PERMIT ISSUED .... f ----------------------------------------- <br /> ---------------------------------DATE ------------------------------------------ <br /> ADDITIONAL COMMENTS . ` �, 7 ...... fC .------- ----•---------------------- --------••- _.....- <br /> •----- <br /> ----•---- --------•-------•--••-•--•----•--•----- _------•---------------------•--------------•--------.------------•---•---_------------•---••--------.... ..._._..... <br /> -- .. -- <br /> --------- <br /> } Final Ins ection b •---• ---•-•-------------••---._.__.........•-••----------................_........Date ----Z. . :L� ... - ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />