Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ...:,tt``1...,...::. � /` (Complete in Triplicate) <br /> . ..._.1�. ................. ,. _ T Permit <br /> . No <br /> ..................................•........_._.... This Permit Expires 1 Year from'Onto fssued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constnrct 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/LOCATIONs ►-S <br /> .......... !.. .............. .:.! : -.. /. .+ ...........CENSUS TRACT <br /> Owner's Name <br /> t _ =._r. <br /> ........................ <br /> Address ... ...... ............. p <br /> _ .... <br /> E <br /> ....... ,...........:.....:CityTc 'T'-D !Y <br /> .. ......._ <br /> Contractor's'Name ......_... !/ / <br /> 1".i. ! s;err .......License ## .S c T phone <br /> Installation will serve: Residence Apartment House Commercial Trailer <br /> C ❑ Own E3 <br /> Motel❑Other...................:...... <br /> Number of living units:...,,.. Number of bedrooms .,,.Garbage Grinder ............ Lot Size .AV <br /> cjl .Gr ...... <br /> Water Supply: Public System and name ...._.._ <br /> Character of soil toad _... .. . �.;--..:.... .�..... .................P►h►ols,� . <br /> epth of 3 feet: Sand D Silt❑ Ci Loam <br /> aY D Peat—�!► L7. lay Loam❑' <br /> Hardpan o Adobe❑ FiII Material <br /> .......... If yrs,type.. . ...... <br /> {Plot pion, 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 see a e it <br /> P p g p permitted if public sewer.is available within 200 feot,I <br /> PACKAGE TREATMENT C SEPTIC TANK <br /> ] Sixe.....:.......................................... Liquid Depth ............. . . ` <br /> Capacity .................... Type .................... Material. No. Compartments ............ A <br /> Distance.to nearest: Well ................... •-----...__.......... Prop. line ......................� <br /> . .......•........Foundation...................... <br /> LEACHING LINE ( ] No. of Lines .........:........... l <br /> _. Length of each line................... <br /> ...._.... Total Length ............................ I <br /> 'D' Box ......_.._:. Type Filter Material .........:..........Depth Filter Material <br /> Distance to nearest; Wel! ...... Foundation <br /> Property Lina ........................ <br /> SEEPAGE PET [ j Dept Diameter Number <br /> . ...---------•--• ..-----•--:...:. ................ Rock Filled Yes ❑ No ❑ <br /> Water Table Depth -..---------------------------------------:.....Rock Size cc <br /> Distance to nearest: Well ................................. .....Foundation . Prop. Lite <br /> 1 PAIR/ADDITION#Prov. Sanitation. Permit# .............- .......:.... Date <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) c�. Lt�@� ................. <br /> �.. <br /> .................................. --••-----••••-• ......... z <br /> (Draw existing and required addition on reverse <br /> -------------•---..-.._ <br /> . g q sidel <br /> 1 hereby certify that I have prepared this application and that the woric will be done In accordance with San *"uln <br /> Cour Ordinances, <br /> h► State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Horns owner or lion. 1- <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 sen <br /> as to become subject #a Workman's Compensation laws of California." Ptar any person in such manner <br /> Signed <br /> •-•---------- ---- - <br /> BY Title --h(if other tanowner)- :. FOR f.�.. _._. <br /> i <br /> s <br /> DEPARTMENT E NLY <br /> APPLICATION ACCEPTED BY ........... <br /> •- .... <br /> -• . .__.._.. <br /> DATE. :--fi �9- C <br /> BUILDING PERMIT ISSUED __...--,----:-:-...__."_._•�.- -_-- - - <br /> ADDITIONAL COMMENTS .........- -- --•- DATE -.. <br /> ----- --_- :--••------...-•--------•••--•................... .............. ...__.......-----..._._.._.. <br /> . .......................... ..................... <br /> --------------------•------ ­--------------------.....__.......---...._. ---------••----------- ------- <br /> Finai Inspection b ...................I...... <br /> P Y' ---------------••-•------�..----.._._.....-------•--•----......_ _ ---=-------..Date ....12-Z..�-.7.co....................... <br /> EH 13 2h 1-613 Rev. 5M ' <br /> SAN JOAQUIN LOCAL HEA ISTRICx $/7b 3M <br />