Laserfiche WebLink
tett OffiLt U*i APPLICATION ICOR SANITATION PERMIT <br /> Permit No. . �.............° <br /> ... (Complete In Trlp"cote) <br />.................................. . ................ Date Issued .7 6 <br />...........:........................... ..... This Permit Expires t Year From Deme 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 Regulationse <br /> .JOB ADDRESS/LOCATION '�.`i`.�.�...."I!' .. �.... ....CENSUS TRACT .......................... <br /> OwnersName ... ................ ?1..1 .._ .. ...... .,...............__....................Phone ..-......... ..... <br /> Address ....----..........:.�.................................. .................•----...............Citv ............................-------•----•----................ .........: <br /> Contractor's Name -• ` - . ............................ -----..........license # ..s�7�rr `�. Phone <br /> Installation will serves Real once GTApartment House(] Commercial❑Trallor Court ❑ <br /> Motel❑Other............................................ <br /> Number of living unite............ Number of bedrooms -_......Garbage Grinder ............ Lot Size ....................................... <br /> -- <br /> Water Supplys Public System and name .................................----...............—..................................................Private W .� <br /> Character of soil to a depth of 3 feet- Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam ❑ <br /> Hardpan❑ Adobe❑ Fill Mcterla) ............If yes,type.......................... - <br /> (Piot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse slde.N <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK{ I Size................................................ -Liquid Depth .......................... <br /> Capacity ...... ............. Type .................... Material........----.......... No. Compartments ......................� <br /> Distance to nearest. Well .................Foundation ...................... Prop. Line ...................... <br /> C <br /> LEACHING LINE [ ! No. of Lines ................... .. Length of each line............................ Total Length <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material .......................................... <br /> Distance to nearests Well -SP*............. Foundation ........................ Property Line ................... <br /> SEEPAGE PIT E ! Depth .................... Diameter ................ Number .............................. Rock Filled Yes ❑ No 0 <br /> WaterTable Depth --•-•-•--•------•...............................Rock Size ---•------... .................. <br /> Distance to nearest: Well ........................................Foundation .................... Prop. !Ms ................... <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ................................-••.•_.•__ Date ...---_-.......- ................ <br /> .Septic Tank (Specify Requirements) .............. ............ <br /> j--.�r•��f� `.......... .......-. ...�.......(r�••.t�v_..._........---..... <br /> Disposal ielci (Specify Requirementsi .. .:........ . <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 Jeaquln <br /> County Ordinances, State Laws, and Rules and Regulations of the Sart Joaquin Local Health District. Herne owner or Ilcen- <br /> std 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 become subject to Workm n's Compensation laws of California." <br /> Signed .. !• ...., ............................................................. Owner <br /> dd <br /> B -•------ ......................... ......................................................... 7itle ................................-....-...................... <br /> . ,. ..... . <br /> (If other than owner) <br /> FOR DEPAR MENT USE ONLY <br /> APPLICATION ACCEPTED .BY . - • - ..------- ..... DATE ..... ....... <br /> BUILDINGPERMIT ISSUED .........................................•..........................---.............................------.DATE --........................................... <br /> ADDITIONAL COMMENTS ............... ........................................................................ <br /> .. <br /> .................................................•.-- ----................ .........I . ........................................................................................................ <br /> ...... .... ............... ..... ............ ..... .... .. ............ ................-....... <br /> I..... ........... ............ <br /> Final Inspection by: <br /> Date �. ..................... <br /> EH 13 24 1-60 Rov.-- •.. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h M <br />