Laserfiche WebLink
FOR OFFICE USE: APPLICATION FORI SANITATION PERMIT <br /> - ----------------------------------•.._ _ ' Permit No. .�:/.-'.Y:.7,.i <br /> {Complete in Triplicate) /' g <br /> F - .. ... -- Date Issued <br /> This Permit Expires i Year From Date Issued' <br /> i --------- -------------- --------------------•----- <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 iV;, compliance with County Ordinance No. 549 and existing Rules and Regulationst <br /> JOB ADDRESS/LOCATION 3 .,-- t.- . .=. .... ... -9---= " �:-- -CENSUS TRACT <br /> ' ' <br /> Phone.............. <br /> nert omaC . - ----------- ..............Address ---- <br /> 's <br /> -- <br /> 's Name . License# Phone ......-Contractor <br /> Installation -•------• <br /> will serve: ,Residence Apartment Hou eG Commercial . railer Court ❑ <br /> Motel ❑Other ------------- -- -- -~ <br /> Number of living units:_- Number of bedrooms ..-=.Garbage Grinder ..------:..\Lot Size ..-- .... :::...... <br /> Water Supply: Public System and{name ____-_-___._..--..... '"•- - - vate <br /> Character of'soil to a depth of 3 feet: Sand'[I Silt[-] Clay„ ....Peat[3 Sandy Loom�❑•`. .Clay Loam D , <br /> Hardpan E3 Adobe❑ Fill"Mt'ferial <br /> 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 seep a pit permitted if"public sever is available within 200 feet) '.r • <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ . Sized t :� '. '-- :_'-- 1 Liquid Depfh . ... :............. <br /> Ca act 5 a e Materialo� Compartments ---. <br /> P <br /> city ------- - -- YP , <br /> i t . <br /> stance to neares : Well __ Foundation :_„_ '.4.`._------ Prop. Line ...:... ............ <br /> r <br /> LEACHING LINE:ay[” No. of Lines ......Y--.............. Length of each' line....._..S-_ Total Length .. ................ <br /> 'D'.. Box Filter Material .-�...R.......Depth Filter Material .-.-.J.Y..r- .---•---,.-.--�'=---••---- <br /> t / oundatidn ---I-0=�------.-... Property Line ---5=---fit - <br /> } a <br /> t �S / ------ <br /> �SEEPAGE PIT. [ Depth nearest: Well ---..�..��------- -F umber ........... Rock Filled Yes [%f No <br /> --�5-------. Diameter �-------� <br /> Water Table Depth --............ <br /> ---.. . a - -----------Rock Size -----`------------ <br /> 0 r j0--.------ Prop. Line .... '------- <br /> 41 Distance,tpinearest;«Well, ._.--�___.--f---- ----------- Fiiuidation,_..---. <br /> �- l I / <br /> riREPAIR%ADDITION(Pref Sanitation Permit# --------------!--------- -------- -- ---:.; Date•_x '` '_..-----------• ...... <br /> .P— 1 , •1 / <br /> s <br /> ' Requirements) -------- '--------------------------------` ---�----- -------------------•------------- ---------...........- ......... <br /> Tank (Spec R q 1 � <br /> I <br /> Disposal Field (Splecify Requirements) _.Z.-------................. ^� `. ' =�� �' - . ...... - ------- .......... <br /> I {: <br /> r (Draw existing and required addition on reverse side) I <br /> I, tify that I, have pre�dred this application;and that the work will be done in accordance I hereby cerwith San Joaquh <br /> County Ordinances, Sfate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven <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 marine <br /> as to become subject to Workman's Com ensatfon'laws of California." f <br /> Signed --- ------.. .. ........... - ...--- - -..............-.........-._. Owner <br /> { �.. <br /> By --!`.............--.... ...........- Title ...--------------- - - 'i'------...-----------------------.. <br /> (If other than <br /> FOR-,DEPARTMENT-USE ONLY <br /> APPLICATION ACCEPTED. BY ----- .......- 1.. .:' DATE r'Z <br /> BUILDINGPERMIT-ISSUED ......................--................................ ----------- ........ -----------'--------------DATE <br /> ADDITIONALCOMMENTS:''----- -t--------------------------------------------------------- -------------------. .....--•................... ------. -- --_----- <br /> �......... - '.:,.. =�'� -----------------------------------------------------......--=-------- ---........ -..... .......- <br /> r <br /> r _4 -------- - <br /> -------------------------- ------------------------ ....... ........... - <br /> - - ._.. _ <br /> .....-r----........I—...-- • ---'� -------'�` -•--_c.....--,�----------- ------ -------t-�"'--� - -- <br /> Final Inspection by: - ......................................Dae -- ... --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />