Laserfiche WebLink
FOR OFFICE USE: <br /> ......... •.. ..... ................... APPLICATION FOR SANITATION PERMIT� Permit No �3.'�37 <br /> ........... I`�: .................. <br /> (Cninpleteln Triplicate) No. . ....... <br /> _..:)l..................... This Permit Expires I Year From bate 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 /> described. Tis appli atian is made In corn I! ce with County Ordinance'No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/i.f CATION ......... CENSUS TRACT ....................... <br /> ... <br /> Owner's Nome f if �. , .......... .............Phone ... ............•................... <br /> Address <br /> --------....i�...._.. _..-• --- -------• - -.. _.7 �.._.-�:,,�,?..�_...�-•�- �-.. City .. . n�'•............................ / ... ...... <br /> Contractor's Name ... .. ..:. r..�.. ......--•...:.................................License #D2111 ... Phone <br /> 1M: <br /> Installation will serve- Residencepartment Housed Commercial ❑Trailer Court a <br /> Motel ❑Other ....................................... <br /> R <br /> F Number of living units:............ Number of rbedrooms _____Garbage Grinder �._ Lot Size .. <br /> Water Supply: P�blit System and name ----. •-•`'fit................ <br /> .._ f .... ....Private Q� <br /> Character of soil to a depth of 3 feet: Sar d❑ Silt -Clay Feat❑ Sandy Loam {] . Clay Loam j] <br /> .... <br /> Hardpan ❑ . Adobe ill MaterigYlf.v . If yes,type ............................. <br /> —--- — <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 it,permitted"if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK Si <br /> [ a ;_. -. Liquid Depth ,� .. <br /> -fiJ. .._ aterial._ 0 <br /> Capacity � f...._. Type ankvh�No. Compartments ...:��r.......... <br /> Distance ,to nearest: Well ...... ......................Foundation'.••-y�.4?. Prop. Line .......... (� <br /> LEACHING LINE [+�No. of lines .......).............. Length v yV61.V_.. <br /> ach line ........._....... Total Length .,�€ .�.............. ��++ <br /> D' Box ! <br /> .P----- Type Filter Materia{ Depth Filter Material .-//..............:._.............:... Z <br /> Distance to riearest:-Well .. Foundation <br /> /f�•-.•---•-•- ./49..............:.. Property Line .............. <br /> SEEPAGE PIT [y]�Depth 5.._:_....... Diameter 3�........ Number .......i__-__._.._- Rock Filled Yes M--No 00 <br /> r <br /> Water Table Depth ------....!...........:.._. .... ..Rock Size <br /> � r / <br /> Distance to nearest: Well ...../. -------------_---------Foundation `...`__._..__._.__ Prop. Line _.,:71r............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# Date <br /> Septic Tank (Specify Requirements) .........._..:.............................:............._......_......---•--••-••-... <br /> Disposal Field (Specify Requirements) ' ....-- ..................................................................• ................................................. <br /> •-----•-••--- ----------- ------- ---------------------------- ............. ---- <br /> g <br /> ;;- (Draw.existing and required addition on reverse side) <br /> 1 hereby certify that V have prepared this application and that the work will be dono in accordance with San Joaquin <br /> County Ordinances, Stcite Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Dean- <br /> sed agents signature certifies the.following: F <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." a <br /> Signed .................)'.......:......... <br /> ._ ................. __. Owner <br /> r _..----...-- • ... y� <br /> By ................. :.....1.'......... _. . .::. '--- `•(, . Title ....... y.l..�.. ._._ ...__...... <br /> (if other than o er : <br /> .I� <br /> FOR,D ARTMENT ONLY I <br /> ACCEPTED -•----..... ,.. ... DATE .. .. ..� . <br /> BULDIINGI�ERM T ISSUED ...............'..........:.: ................. r..__... .- = DATE ..........__... ..._.................. <br /> ADDITIONAL COMMENTS . - :;:•---•.................................•-`---•-----••--..._... .................... --- - <br /> . ...... <br /> ----•--••--•...............!I_...._... .._..__.. ................. -- ... <br /> •--- - ••- -•- <br /> Final Inspection by'. . .......................................Date ............... . .......... <br /> ..�_- ,,. ,,;,,_,_.:SAN .JOAQUI LOCAL HEALTH DISTRICT , <br /> 4. <br /> E. H. 13 24 J..68 <br /> Rev. 5M 7/723.,4 <br />