Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOP. SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. -.------.--5 <br /> ------------------ ------------------ This Permit Expires 1 Year From Date Issued <br /> 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. This application i made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> ,� ,tee. Y , -_0- .� 6' <br /> JOB ADDRESS/LOC ION . -___ ,., __ s4-�- a-------------------CENSUS TRACT ._----_------------------ <br /> Owner's Name ----- j ------ --------------Phone ---------------------------------- <br /> 4i I <br /> Address --------tf / �� +z ,� --------------------------- <br /> - -------- Cit <br /> Contractor's Name - --- ------`-- -- --- -_ --.License # � c33''--- Phone ------------------------------ <br /> Installation will serve: Residence Apartment House 10 Commercial ❑Trailer Court i❑ <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 E] Adobe ❑ Fill Material ------------ If yes,type ---------------------------- <br /> (Plot plan, showing size of loft, 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 ---------------------- <br /> Distance to nearest. Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------. <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 IQ <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well -------=-------------------------------Foundation -------------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------- -- Date ----------------------------------) <br /> SepticTank (Specify Requirements) -------------------------------------------------------------------------------------------- ----------------------------------------------- <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------- --------------------- <br /> --------------------- ---- - <br /> r./.�. - � - ----------°--- ----- --- --------------------- <br /> --------- ------- ------ --- --------------------------------------- - ---- - --------- --------------------- <br /> (Draw existing <br /> and required addition on reverse side) 4 <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 become subject to Workman's Compensation laws of California." <br /> Signed -------- ------------ ----- Owner <br /> -�--- --------------------------------------------------Title ------ =-------- - <br /> By ----- �"�" <br /> -- <br /> 6 <br /> ----------- <br /> {If other than owne ) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE -6__1fr--- -------------------- <br /> BUILDING PERMIT ISSUED --- ---------------------- --------------------- -------------------------------=---- <br /> -------DATE ------------------------------------------- <br /> - - <br /> ADDITIONALCOMMENTS ------------------------------------ - - ---------- ---------------------------------------------------------------------------- <br /> --------- <br /> --------------------------------------- <br /> Final <br /> ------------------------------- --Final Inspection by: ------ - _ ---------------------------------------Date -- -_ -` <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H-.`9' 1-'68 Rev. 5M <br />