Laserfiche WebLink
i <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ------- -------------------- --------------- - Permit No. --7--�i-=--Z-� <br /> (Complete in Triplicate) <br /> This Permit Expires 1 Year From bate Issued <br /> Date Issued <br /> --------------------------------------------------------- <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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOC ION - -- ----------------- CENSUS TRACT - <br /> Owner's Name - { Phone <br /> -- ------ -- ------ <br /> Address /1-. -- - �. City `moo`°' ""' ----------------- ------------------_-- <br /> 5 <br /> Contractor's Name --------- -- -- �- P -.License # Jd!-33-g y-.---- Phone --_---_--------_------------ <br /> Installation will serve: '-Residence Q4 Apartment House f❑ Commercial:❑Trailer Court ;❑ <br /> Motel ❑Other -'---------------------------------- ----- <br /> I <br /> Number of living units------------- Number of bedrooms .-3----...Garbage Grinder .-.---- Lot Size --` ` "` ---------------• <br /> Water Supply: Public System.and-name --------------=------•- ---------------------------------------------- ---------------------------------------Private PE <br /> Character of soil to a depth of 3 feet: Sand'❑ -Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam <br /> El <br /> Hardpan ❑ Adobe .[ Fill Material ------------ If yes, type ---------------------------- <br /> (Plot plan, showing size of lot, location of system in '1 lation to wells, buildings, etc. must be placed on reverse side.) ` <br /> F NEW INSTALLATION- [No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> SE <br /> TIC TANK [-] " ' Size Liquid Depth -------------- ------ <br /> PACKAGE TREATMENT [ ]_ P 4. <br /> i <br /> Capacity - ----------------- Type --------------------- Material----------: ----- No. Compartments --------------..------ O <br /> Distance to nearest: Well ----------- -----Foundation ------------- ------ Prop. Line --------------..------ <br /> f LEACHING LINE [ ] No. of Lines ------------------------ Length of each line------------------------ -- Total Length :----------_-------------- <br /> 'D' Box I.----------- Type Filter Material --------------------Depth Filter Material -----------_------------------•------------- <br /> Distance ------------------------to nearest: WellFoundation -- --------------------- Property Line -------- --------------- <br /> _- T Depth --- Diameter -- Number __.------------------------- Rock Filled Yes ❑ No i❑ <br /> SEEPAGE PIT [ ] p ---•---------- <br /> WaterTable Depth -------------------------•----------------------Rock Size -------- ----------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --------..---.--. <br /> REPAIR./ADDITION[Prey. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> SepticTank (Specify Requirements] -------- -----------------------------•------------------------------------------------------:------- ----------•--------------------------- <br /> ' Disposal Field (Specify Requirements) _ - - --_- mac-a----- --- -------- <br /> ( � � �- '� <br /> f <br /> -----------------------------------------------------------------x- <br /> =------------------------------------------------------------------------------------------------------------------------------ <br /> (Draw existing and required 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 licen- <br /> sed agents signature certifies the following- <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ----- ---- �• Owner <br /> B = � , ---- ------------------------ <br /> --- ---------- Title -- ------------- -------------------------- ---------- <br /> [I other than owner] <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- - - - -'--- ---- --------------------- -------------------------------------- DATE -f-_/1" <br /> BUILDING PERMIT ISSUED ------ -------------------------------------- -------- <br /> ------------------------------------=--------------DATE -------------------------------------•---- <br /> - <br /> ADDITIONAL COMMENTS -------------------------------------------- ----------------------------------- -------------------------------------------------=--------------------------- <br /> - - <br /> ----------------------------------------------------------------------------------------------------------------- <br /> "- a-t--e- <br /> --------------------------- - --- --- -------------- ------------------------------------------------------------------- <br /> Final Inspection by: - -- <br /> '? ---------- <br /> -------- - ----- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />