Laserfiche WebLink
FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT <br /> ......... ...................................... <br /> (Complete in Triplicate) <br /> Permit No. <br /> ....................................................... This Permit Expires 1 Year From Date Issued Date issued e: S <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 Regulations: <br /> JOB ADDRESS/LOCATION ..45-92.0.___.` -//.A&V..l. .P--...,�!/�/�e It -..,..CENSUS TRACT .......................... <br /> Owner's <br /> �... � -Or�.�_�f�ie ..,.. �. '�.s......�skr�r�Phone . . ........................ <br /> Address ,./'4d.-......- •-------- ---------------------City ...lf�rf��c?,��.���........................_ . <br /> Contractor's Name ...efent i�:.. ........................License # -;�5_ 172.. Phone ......... <br /> Installation will.serve: Residence❑Apartment House Commercial ❑Trailer Court <br /> Motel ❑Other............................................ <br /> Number of living units:............ Number of bedrooms --------.---Garbage Grinder ............ Lot Size ............................................ <br /> Water Supply: Public System and name ............................................ ................................................................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ <br /> Hardpan ❑ Adobe❑ 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 [ SEPTIC TANK } Size................................................ Liquid Depth .......................... <br /> Capacity -------------------- Type .--------------- --- Material................... No. Compartments ......................tP <br /> Distance.to nearest: Well ................Foundation ................... Prop. Line ......................0 <br /> LEACHING LINE [ } No. of Lines ------------------------ Length of each line............................ Total Length ' <br /> '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 ❑ No <br /> Water Table Depth --------------------------------- --------------Rock Size ......................... ------ <br /> Distance to nearest: Well ..............___....................Foundation .-.........-....---- Prop. Line ..._.................� I <br /> REPAIR/ADDITION(Prev. Sanitation Permit# __- ------------------------------------ Date .............----..........--_---•) <br /> 3 <br /> SepticTank (Specify Requirements).....----------•----------------------•................................. ------- =---------- ..................... ------ <br /> Disposal Field (Specify Requirements) . <br /> --------------------------------------------- --- - ------------------------- ...................... ------------------- .............. <br /> f 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 <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Home owner or licen. <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 manner <br /> as to becal bjec to Workman's ompensation laws of California." <br /> Signed ---- --- .=---- -••--------. Owner <br /> BY ..-.. :own - Title . <br /> If (If ofi er than owner) ----------------------------------- <br /> F R DEP RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - - .. .---- DATE ---------- <br /> ----------------------------------------•--------- •- <br /> BUILDING PERMIT ISSUED --------------------------------------------------- ----------.-DATE ---- ................. ---------- <br /> ADDITIONAL COMMENTS ----------...............I.................. <br /> ...-... <br /> ------- --- .-.-... ------.... ... <br /> Final inspection by: c .P ... ---•--•-•----------------------------------- -- CJ`/.. ._ <br /> -�--- - ---••---• --.......©ate --� •--- ............... <br /> EH 13 24 1-68 Irv. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />