Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PER <br /> - --- --- --- - ---- ------------- <br /> (Complete in TrMit No.iplicate) <br /> ---------=------------------------------ ----- <br /> --------- This Permit Expires 1 Year From Date Issued Date Issued <br /> ------------------------ ----------------------- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct an'AgtaIW6 work herein - <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> -70-7- F- . ter', ►��.�r - , f ekun;U r <br /> JOB ADDRESS/LOCA N - m°------- ° "`' ''� -�� ------CENSUS TRACT ------- ------------------ <br /> Owner's Name --------- - --- ----- - -----------• -------------------------- -------Phone ---------------------•-------------- <br /> Address - ---- -- - - ---- --- ---- ---- Y <br /> Contractor's Name ---------- '�""�`' ' License # _14N. Phone --------------------------- <br /> Installation will serve: Residence E Apartment House❑ Commercial ❑Trailer Court i❑ <br /> Motel ❑ Other ______`)'>'�-�----- <br /> ^^ ___, <br /> Number of living units:_________ Number of bedrooms ----7r---Garbage Grinder ------------ Lot Size --- <br /> -_ ------------------ <br /> Water <br /> _______-___Water Supply: Public System and name --------------- ----------------------------------- - --------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loom •❑ Clay Loam [e' y <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ___________________________ <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 pit permitted ITf blic sewer is available within 200 feet,) a <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ]1 Size_ - ----X--- - -- --- k,- - ___ Liquid Depth __ ___________ J <br /> -------- <br /> Capacity 1-�--o,r_JA4 <br /> p y _ V Type may____ Material___�'�_ '�-_�_-- No. Compartments -----_____----_....... <br /> `s ---------------------rFoundation __�_�_-_____-_ S <br /> Distance to nearest: Well ---------------V ___-- Prop. Line ---------------------- <br /> LEACHING LINE [ No. of Lines --------e------------- Length of each line---------- _00-_-____-_ Total Length _____-----_-__ <br /> 'D' Box ------------ Type Filter Material ----6__4-------Depth Filter Material ------/I---------------------------------- <br /> Distance <br /> _ _____________________________Distance to nearest: Well ----- - ________ Foundation ------/-40--/_________ Property Line _____ ____ ___________ <br /> SEEPAGE PIT [ Depth ____--_off- _ Diameter _�3_b..... Number .___ -. <br /> _ /__________________ Rock Filled Yes No C] <br /> ! .o •! <br /> i <br /> Water Table Depth ----------7B________________________________Rock Size ____ __ ______X__ _ <br /> i <br /> Distance to nearest: Well ----------r_a_A_�__________________Foundation ---------I-_P__-�__ Prop. Line _____s ........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) <br /> Septic Tank (Specify Requirements) -------- ------------------------------------------------------------------------------------------------- ---------------------------- <br /> Disposal Field (Specify Requirements) -------------- -------------------------------------------------------------------- ----------------------•--------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <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 C ensation laws of California." <br /> Signed ----------------- ------- } Owne <br /> 1011 <br /> By --------------------------------------- s---- -------- <br /> - - - Title - -- <br /> -- - --- ----- ---- --------------------------------------- <br /> (If other than owC-d) <br /> RPIPARTMENT USE ONLY / <br /> APPLICATION ACCEPTED BY - --- --------- ---- ---- - ----------------------------------------------------------- DATE -l �!------------------ <br /> BUILDINGPERMIT ISSUED ------------------------------------ ------------------------------------DATE ------------- ----------------------------- <br /> ADDITIONALCOMMENTS --------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ --------- <br /> -------- --------- ------ ------------------------------------------------------------------------------------ ----------------- <br /> --------------- --- - --------- <br /> Final <br /> - -- - - --- - - -- - <br /> Final Inspection by: G --------------------------------.Date ------ --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. 5M <br />