Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> � <br /> (Complete in Triplicate) <br /> Permit No.. 7�--y6 6' <br /> Date Issuecf.s.�. <br /> ---------------------------------------------------.--.-- This Permit Expires 1-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 described. <br /> This application is made in compliance <br /> -}}with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIO J. <br /> Q --� <br /> b .... CENSUS TRACT------------------ ----- <br /> Owner's Name. ---- - ----- --- .. ..... ..¢1�. Phone,.�? "`S/IV--()---- --- <br /> Address........... Q. ry`"/^ g� Q - City ---•--•Zip------------- ---------- --- <br /> Contractor's Name .... - dZ�.✓.. -License #. .5..5�-3.5�.3 Phone S�-O- --9(D_.7._.. <br /> Installation will se ve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> r Motel ❑ Other----------------------------- --------.... p �/ <br /> Number of living units:-----!-........Number of bedrooms.. -Garbage Grinder--_.-.__..Lot Size..f.9.(.. 1...z 7 <br /> Water Supply: Public System and name--------•---•---- ......... ---------- -----------------Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe GC' Fill Material.. .........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 seepage pit permitted if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT [ ] SEPTICTANK <br /> Q Size._- x_./+ -__.___._....__-------------------•Liquid Depth -.✓` _.le_-_----..._._� <br /> Capacity_(e3- ---•-.-•Type..1.-�--.---Material_..L-s'��_...-.No. Compartments------7 .....................Cj <br /> Distance to nearest: Well__...1d -----------------------------Foundation.--_ .......__ Prop. Line._S-_-_ <br /> r � <br /> LEACHING LINE No. of Lines.._-.-..-. .._.__... Length of each line------a'5...............Total Length -----/2.0... <br /> 'D' Box.----.Type Filter Material.__ . Depth Filter Material ....._..l_C�_1IF....... <br /> .._ _.__.__... <br /> Distance to nearest: Well. / �........Foundation_._.I.W..Y"..____._.Property Line.-----4 �.... .............. <br /> 1� r[ <br /> SEEPAGE <br /> PIT QQ De th ..72-.5'._ -Diameter._._ <br /> p -.._..___.Number_.._.___..� .______.__.__ Rock Filled Yes No ❑ <br /> Water Table Depth------- - --------- ----------------------------- ---Rock Size-_. . _ ..�� . <br /> _ --------------------- <br /> Distance <br /> ---- -- ----- <br /> [ l <br /> Distance to nearest: Well------ --------------------------Foundation... ........Prop. Line -5......... .- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#--------------------------------------------------Date....................._-----------------------) <br /> SepticTank (Specify Requirements)--- .......__...... -------------------------------------- ------------------------------------------------------- --------------------..--- <br /> DisposalField (Specify Requirements)----- -------- - ---------------------------------------------------------------------------------------------------•------------------------ -- <br /> ------------ --•---•--------- ----------------------------- -------- ---------------------------------- ---------------------------------------------- - - -_.....----.-- ........................... ...... <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 County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> 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 as <br /> to become subject to Workman's Compensation laws of California." <br /> Signed--------- -------- --------- --- Owner <br /> BY <br /> . ..... ........ <br /> f <br /> other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- <br /> DATE . r <br /> DIVISION OF LAND NUMBER .... . ......... .... .... . .... . ---------------------------------------------- --DATE------- .................------------- <br /> ADDITIONAL COMMENTS. - -----------------------------I.....--.-------•------- -------- -- -•--- ------ <br /> -------------------­---..----------------------------------------- <br /> ---------------•--•------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------.---------------------- <br /> ------------------------------------------------------ -•--------...---------------•----------------------•------------------------•------------------------------------------------------------•--------------- <br /> Final Inspection by-------- ----Date..------- --�--------I--- --- ...... <br /> E" t3 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fad REV- 7/76 3M <br />