Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE:qt� APPLICATION FOR SANITATION PERMIT <br /> /02.-_..f Q -•------- Permit No. ��� <br /> (Complete in Triplicates <br /> ..........I......•........ -- <br /> This Permit Expires 1 Year From Date Issued flats 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 compliant ounty Ordinance No. 549 and existing Rules and Regulations- <br /> tZ'JOB JOB ADDRESSAO�ATIION ........._.. ....... ........ ....................•••....CENSUS TRACT ._..................... <br /> Owner's NamePhone <br /> Address _.- <br /> --------------------------- -- - - - •-�.-. -.•- -•---- .._. City <br /> f01".. Phone <br /> Contractor's Nametense <br /> i <br /> Installation will serve: Residence of.Apartment House fl Commercial❑Trailer Court C] <br /> Motel0 Other...............................•......... <br /> Number of living units.-_!-_----- Number of bedrooms 2:Garbo Grin er _ ... tot S � o � / <br /> :.. <br /> k Water Supply: Public System and name ...........................................-•--• :.. �� .r .............Private ❑ <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Pat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan❑ Adobe 0 Fill Material ............ If yes,type............... ............ <br /> (PlotP Ian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No Aseptic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ SEPTIC TANK; } Size. <br /> ............................................... Liquid Depth ._.................._....-C} <br /> Capacity -------- ----------- Type ................ ..r Material........----•---••--•. No. Compartments .......•--............ <br /> - it <br /> Distasice to nearest: Well ................:..s_____.___-_..--Foundation ...................... Prop. Line ..................... <br /> LEACHING LINE ( j No. of Lines.------------ ----------- Length of each line....................•...•••. Total Length ............................ <br /> I 'D' Box ---------- Type Filter Material .....................Depth Filter Material ............................................ <br /> ' Distance to nearest: Well ....................... Foundation -...------.............. Property Line ................... <br /> SEEPAGE PIT ( } Depth -------------------- Diameter ................ Number ............................ Rock Filled Yes 0 No ❑ <br /> Water Table Depth................................... .Rock Size <br /> f Distance to nearest.• Well ......Foundation .................... Prop. Line ................... . <br /> REPAIR/ADDITION(Prev. Sanitation Permit •----------------•-- Date ------------ ..................... <br /> Septic lank (Specify Requirements# _f..._ � •................ <br /> F Disposal Field !Specify RequiremeZ_11.�, ___�0-___C_t_< <br /> �:. �� ... �- z6� ................................................f....----- --- --- LQf <br /> ............... <br /> ••. <br /> X �-r' - - ...............................••----._..---.........-••.--........ <br /> - -(Drow existing fired ddit on reverse side) <br /> 1 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. Nonce owner or lieen- <br /> sed agents signature certifies the following: <br /> "I certify th*inheert m nce of the workfor which this permit is issued, 1 shalt not employ any person In such manner. <br /> as to becomman'sNCompensa ' n laws of Iifornia."� � ��G �%Lli�Signed ....... .--- -• -- = Owner % n <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY,. - - - -- • •---•------•-•---------------•----------........................ DATE . �f�. T r--------- ....... <br /> BUILDING PERMIT ISSUED --------- -------------------------------•-------.•-_.-------.....-------------------------..._.-----.-.-DATE - <br /> ADDITIONALCOMMENTS .._._....' --------------- ................................................. -•..-._--_--------------------..- --•--------•--- <br /> ------- ------- -� -'-- --•-------- .-. . ... -----------• -------------- -------------------------- --------------.---_..--_..........._................ <br /> ------------------------------ <br /> --------- <br /> -----------------•----- "-- .. �p - <br /> Final Inspection by. ,`' " '. --------------------- ----------- •-•---....-------••---............_.._....Date .�.'p l.. /A... --•-------.._.._ <br /> EH 13 2L 1-68 � A UIN LOCAL HEALTH DISTRICT 8/7)1 3M <br /> SAN JC* Q <br /> E <br />