Laserfiche WebLink
rv,z VirVI" Vous <br /> . . ..................... II APPLICATION FOR SANITATION PERMIT <br /> (Complete In Trippcate) Permft . <br /> ................ •':fir.. This Permit Expires ! Year From bah Issued _ Date issued <br /> Application Is hereby rno&to the San Joaquin.Local Health District for a permit to construct and install the work herein <br /> described. This application is mode In <br /> In compplliiaance with County Ordinance No. 549 and existing Rules and Regulations, <br /> JOB ADDRESS/L TION....s ��..,,fir'. .�:. ..... ....... *. CENSUS TRACT_ .»..: <br /> Owner's Name �1. .. ......... ..Phone ._P�.0�:W1..:..:.. <br /> Address ............................ .... ... .�._. .........'' .....,gtyT._ e'''}.. ........................................... <br /> Contractor's Name ..�, :�c.';, , ......... <br /> �r ........----•............._..--.......License#� ... Phone <br /> ` Installation will server Resider a • •„ <br /> (Apartment House E) Commercial C]Trailer Court 0 <br /> Motel❑Other--••-•--••..................4.. ...... ` <br /> I Number of living unttat_. ,;. .... Number of bedrooms I.-..-....Garbage Grinder,.....--- Lot St" <br /> . <br /> Water Supply,-Public Systef and name j ..................................:::...:. ..��......._..._......_............ <br /> �....-.........Private........... <br /> i Chorocw of soil to a depth:,of 3 feet, Sand 4 Silt Q Clay Q Peat❑ `Sandy Loom ❑ Clay Loom C3` <br /> t <br /> Hardpan❑ Adobe Q Fill Material ' <br /> ......�....If ye:,type•........:........_....... <br /> (Plot plan, ahawing size of lot, location of system in relation to wells, buildings, etc. must be plated an reverse side.1 <br /> NEW INSTALLATIONt (No septic tank or seepage pit permitted If public sewer is available within 200 feet.1 <br /> t PACKAGE TREATMENT [ ] SEPTIC TANK( Site......................... ..................... Liquid Depth .:..................... <br /> .. <br /> I, CaipaNty Type .................... Material.......:'.. - . ... No. Compartments:. ............. <br /> Diitance to nearest: Wall' .... ...... .. ........:..........Foundation ................. Prop. Lino l." <br /> LEACHING LINE { } Nol of Lines ...... •---•---ti-._,length,.of* ap_�............ .... ----- <br /> �_ _ endue Zine. Total <br /> 'D'i�Pox . ........ Typo Filter Material ._...4 Depth Filter Material Z&.......................... . <br /> i <br /> Distance to nearest: Well ........................•Found tion R .......--........... Property Line M r< <br /> SEEPAGE PIT f D Depth .................... Diameter Nu ��.......... .............:.. Rock Filled Ye; No [ <br /> woler Table Depth ......................... ................... <br /> ... .Rock Size ..... C <br /> Distance to nearests Well ............... 1•.........-Foundation ........ ........... Prop. Line ... _ . ... 5� <br /> 1 1. <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ................................... . ......... Date .................................. <br /> } <br /> Septic Tank (Specify Requlrementsl ...............j ...................... ..._. »................ ............ - E».... i <br /> Disposal Field (Specify 'Requirements) ...1 X1i ..................... ...... . <br /> ....................................::.... .!f: ...... ..............• - ............. .. .......................... ....`.:.............................. .....: : .... :: .:.. ! <br /> . (Draw existing and required addition on reverse side) <br /> I <br /> 1 hereby certify that I have,prepared this application and that the work will he dans in accordance with San JmMuto <br /> County Ordinances, State Lave, and Rules and hgulalions of the San Joaquin Local Health Distrid. Home awrtar or ltcen• <br /> sed agents signature certifies the followings <br /> "1_certify that in the porforrriance of the work for which this-permit Is issued, 1 shall not employ any persons In*such manner <br /> as to becomee�subject to Worlkman's Compensation lavers of California." <br /> Signed.,_[ -. .. �� II ........._.--------- ----- ----------•-•-•-------•- Owner <br /> . ; <br /> By............................... ....... �� ..... ...... <br /> .......... <br /> .... -- Jitle ...................................-.............:................... <br /> . . ..... . .... <br /> (tf other than owners <br /> FOjt DEPARTMENJ USE ONLY <br /> APPLICATION ACCEPTED 81f-.... :................... BATE ; :;.:.;ltJ7_ _::.:: <br /> BUILDING PERMIT ISSUED..,. <br /> A1TIO ' L CO ENTS ... ........................D TE ;V[ <br /> ................. ..... ...:: !(. .-•-- ..-_.....-....._..... ..............._........ ............................ :........ ............................................. <br /> Final Inspection bye . .................... ......................................Date �,!`—:• 7.7................ <br /> EH 13 Qji 2 �: ..... <br /> • SAN JOAQUIN LOCAL HEALTH DISTRICT 6/A 3H <br />