Laserfiche WebLink
-FOR OFFICE USE: <br /> SPO Z.- : PI C- i C(� <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete in Triplicate) <br /> ---------=----------------------------------------------- / <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 is made in compliance with County Ordinance No. 549 and isting es nd Regulations: <br /> JOB ADDRESS/LOC TION .-_J_ _�+_4� - ------�_e------ CJ_ ��t: - -------CENSUS TRACT ------------------------- <br /> A J <br /> Owner's NameV-- el � Phone----- <br /> Address --- ` I '�► 1 Rte_`-------•--._-. City --------------------------- --- ----- �� <br /> Contractor's Nam ­_.1S_'___/____1S_________ __.License # _I.7_?_� -3___ Phone ________________-.. _--_ <br /> --- ------------------------------- --- <br /> Installation will serve: Residence Gp'Apartment House❑ Commercial ❑Trailer Court i❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:------I.__- Number of bedrooms __!________Garbage Grinder`_____ Lot Size d �. <br /> Water Supply: Public System and name ------ _ __ .--. _.-_-_,_--_____ ___--___ ____ _________Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam lay,Loam ;❑ <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 it permitted if publicc�s7wer is Available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK'[ Sizek25-. __-!_. ________ ________ Liquid Depth -_�_______---- 1 <br /> Capacity ___"_jWType ''�_c..� Material_ No. Compartments ........... <br /> `Distance to nearest: Well _____ _ foundation _____�_ _______ Prop. Line .............. <br /> ------------------- -- <br /> LEACHING LINE [VI No. of Lines ---I------------------- Length of each line--Y-0------------------- Total Length ---- ................. <br /> 'D' Box o��___ Type Filter Material _ 41�__.Depth Filter Material 1�__ ______________________________ <br /> Distance to nearest: Well --------- Foundation ___________________ Property Line ________________________ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ______________ Number _______________ ------ Rock Filled Yes ❑ No i❑ �0 <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 /> ------------------------------------------------------------------------------- -------- - -- ------- -- ------------------------------------------------------------------------------------------ <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 b)e to Workman's Compensation laws of California." <br /> Signed ----- --- ------------- -Is - ------------------------------------------------- Owner <br /> By ------- ------------------- ----------------------------------------------------- Title --- --------- - --------------------------------------------------- <br /> (If other than ow ed <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED ------------------------------------- ---------------------------------------------------------------DATE -------------•----------------------------- <br /> ADDITIONALCOMMENTS ------- ------------- ----------------- ----------------- ---------------------------------------- ------------------------------------ <br /> ------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------- --------- <br /> -------------------------------------------------------- ----- <br /> Final Inspection bc—'1 <br /> P y: -------------- ------- Date -j ��' <br /> SAN JOAQUIN LOCAV HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />