SU0006022 SSNL - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ....... ..::.......... -. . ,. Date Issued...:'_.....'... . ........... . ... ___ . - This Peri-nit Expires 1 Year From Date Issued pplication is hereby made to the San Joaquin Local Health District.-for a permit to construct and install the work herein described. 'lis application is made in compl'ance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .... 71114_ ... .. `� !....y:.! '...... .s. :';- _::•?.....CENSUS TRACT.............. 1caner s Name.... .. .... .. .......... Phone_................. ............ ..... ..... .......... .. ..... ��., •. Address.. '... .�.. .......�.... .C:i+ ...:�..I" . . ........... .':''_.._«::...... ..... City. ......... .. ... ....... ...................Zip--------- ......... ontractor's Name........ ....._.........cWit_et�_ _.. ....._... ...". lstallation __.. will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-----' -r.?.. .._...... ................ umber of living units:...... ......_Number of bedrooms............Garbage Grinder............Lot Size..........................._......_.....-..... vJater Supply: Public System and name....... ...... ................... Private (] "haracter of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ] Fill Material............If yes, type.......... ..................... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) EW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r . -- PACKAGE TREATMENT [ ] SEPTIC TANK (']� Size........... ----- -- - -- - - ---Liquid Depth........L_ Capacity....f2c;.r, .. Type.•-ircca,..---....Material._.. 4 . . '`.`_..No. Compartments---......... wv Distance to nearest: Well ...........f��..::%:__:..- ...Foundation .......1 . . .. ......Prop. Line........'............... . 1 LEACHING LINE [ ] No. of Lines....... .......)............ Length of each line.. .....` ...... Total Length ......%)... ................. 'D' Box_........ Type Filter Material.:':<.; ;-t._.. Depth Filter Material.. .....1� ... ............................. ------� Distance to nearest: Well........ � _........... Property Line..... .-`� �.:?.-._.... .._..... ' `EPAGE PIT [ ] Depth................Diameter.....................Number.........._.-----------._.--- -- Rock Filled Yes ❑ No ❑ Water Table Depth................ ........` Rock Size.... Distance to nearest: Well...........................................Foundation.... . .... .. ..........Prop. Line_......-------..._. .- EPAIR/ADDITION (Prev. Sanitation Permit#...................................................Date............. ... _-----) Septic Tank (Specify Requirements)..... ..... -----------------------------------------_ -......-------------- ----------..---...-...--......------------------------------- iisposal Field (Specify Requirements)..... .. .._......... ------------------------------------------------ -------...------...--•------...--- ----- --------------------- ........-•---•....... ..... . ......................... .. ....................•------ .................................................. ................................................. ....................... ..................... . --•-------....-.....-------.-........-- •-- ........_......................I...... ------.......................... ........ (Draw existing and required addition on reverse side) hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents gnature certifies the following: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become .S"bje to orkit3arCompgpsation laws of California." igned X..., _... ........... ---..Owner B ................. .--- --................ --..... _... __ Title-- - _ . .............._.. (If other than owner[ F()R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... s-•.." cy,xn��. . .. . DATE ... . i'.7";._. ............. ....... .. - -. )IVISION OF LAND NUMBER..................... DATE. \DDITIONAL COMMENTS . ... ... ... .... - -_.. - - -... _........-_. -. .....----•---..... ..................... ...... _.. ......................... ... ........ .... . sinal Inspection by:. -------------------------------- -- - ------ Date 6 3M 11 — OAKI i/1Ar%1Itki Ir1r'AI UrA:TW n1CTD1r"T F8521677 Rev 7 7/