Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ... ...................................--------,........ <br /> Permit No <br /> (Complete In Triplicate) . ..................... <br />......--- .................. ...... <br /> w <br /> This Permit Expires 1 Year from Date Issued Date Issued. .: <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> describer!. This application is made in complia c wi County Ordinance No: 549 and existing Rules and Regulations: <br /> ri O <br /> JOB ADDRESS/LOCATION .. '. ........ ..•.....-.. ..... TRACT .......... <br /> a � <br /> Owner's Name ...:... �... .. .. ...............,................ Phone ......,.. ................ <br /> ,.. <br /> Address . .. ......� 7 2if .. � ...... .......... City . . ........................... <br /> Contractor's Name ---.. _ __ . . Phone .............................. <br /> Installation will serve: Residence&A"partment House Commercial❑Trailer Court 0 <br /> F 1 Motel ❑Other .............................................. <br /> Number of living units:_....�_..... Number of bedrooms ...t-------Garbage Grinder... ....... Lot Size ....-..fe— ...•.........._. <br /> Water Supply: Public System and name ........................:......................:.......................Private ❑� <br /> Character of soil to a depth of 3 feet: . Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom 0 Clay Loam ❑ <br /> Hardpan W 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: (Na septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK i Size........................................:....... Liquid Depth ......................,... <br /> Capacity - Type .................... Material.-......_............. No. Compartments ...................... S <br /> Distance.to nearest: Well .................... ....Foundation ........ Prop, Line <br /> LEACHING LINE [ ] No. of Lines ........................ Length of each line............................ Total Length ............................ 0 <br /> '©' Box ....... Eype Filter Material ...:................Depth .Filter Material ............................................ <br /> . <br /> ' Distance to nearest; Well ......-.............:. Foundation ........................ Property Line .........--. ....... S <br /> SEEPAGE PIT [ ) Depth ...... ..... Diometee ----•-------:'-- Number ............................ Rock Filled Yes ❑ No C) <br /> Water Table Depth --.....Rock Size .............:.................. <br /> Distance to nearest: Well .....__._Foundation .. Prop. Line ...................... <br /> } <br /> REPAIR/ADDITION(Prev. Sanitation Permit# Date ...:..........-.................... <br /> Septic Tank (Specify Requirements). ' ` <br /> o I Fie <br /> (Specify Requirements),�___ t.. >_. �,_ V �,.. <br /> --- •- .... ............. ...... ........... <br /> - <br /> C .........::.:. :. <br /> . .. { w existing and requir d 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 liceb- <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 become subject to Workman's Compensation.laws of California." <br /> Signed --.• -------- Owner <br /> By _..._ •----------------_--- - <br /> -------------- --��`-- '-- ---... Jule <br /> (If other than awned ; <br /> _ FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY =--63 <br /> _ DATE /6 rl <br /> _. .. <br /> BUILDING PERMIT ISSUED -7.. . ...........:. ........k::--•---------- ------ -------- ....------------....---DATE :-_------------- ........................ <br /> ADDITIONAL COMMENTS -•-----•--•- ------ -------------------------------------- ................ <br /> ------------------------------------------------------------- -------- ------•---- --------------•--•--------•- •------_­1------ ----- -------- <br /> ------------------------- <br /> ---------•-•--.... ----------------------------------------------------- --------. ------------._-------------•.-..-. --- ---- " <br /> `._ ------.,,.-•- •-- ------- <br /> Final Inspection by: ---------------<� .-..---•...._ ,..Date .?. /G��.� <br /> -- .....•.............. <br /> EH 13 24 1-68 Rev. � f SA JOAQUIN LOCAL HEALTH DISTRICT 8/713 3M <br /> A <br />