Laserfiche WebLink
VW art=rte Usti APPLICATION ICOR SANITATION PERMIT �`. <br />................... .�. .......,.ti..............,,. (Can .Permit No. <br /> (Complete in Tr1p11catel ..�7.:.�l <br /> ............................. <br />.................I... ._ .... This Permit Expires Year From Date Issued F _„ws• Date"lasued` <br /> Application Is hereby evade to the San Joaquin Local Health District for a permit. to construct and install the work herein � <br /> described. This application Is mode In compliance with County Ordinance No. 549 and existing Rules and Regulations: ` <br /> JOB ADDRESS/LOCATION .. .Z la. ..� . .. . ........ .................CENSUS.TRACT ............... <br /> Owner's Name ....6 ................................................... .......-........ .....,........Phone ..... . <br /> Address ... .Z� �...f 4edence�rGniikp'artment <br /> �� :..............................City ... ..........---................._....... .. <br /> Contractor's Name --- --•�---- . . ................................................License � .'� ....�.�li�... Phone .. . ...................__... <br /> Installation will aervo� Housso Commercial❑Trailer Court ❑ <br /> Motel❑Other............................................ <br /> Number of living units:............ Number of bedrooms ._ ......Garbage Grinder --____------ Lot Size ---•........:............................... <br /> - i <br /> Water Supply: Public System and name ................................ ._----................_......._.........:______._.............._____.._..Private <br /> Character of soil too depth of 3 feet: Sand o Siit CJ Clay ❑ Peat d Sandy Loam ❑ Clay Loam ❑ f <br /> Hardpan❑ Adobe❑ ;Fill Material ............If yes,type ............... ............ <br /> (Plot ran, showin size of lot, location of g <br /> p g system in relation to wells, buildings, etc. must_be_placed on reverse aide.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer.is available within 200 feet,l <br /> PACKAGE TREATMENT f ] SEPTIC TANK J Size--!............................................. Liquid Depth ............•........... <br /> Capacityj,� Ype - - aterial. ............... No. Compartments ...d ............. <br /> Distance to nearest: Well . ..Foundation -_ Prop. Line � � <br /> ®.� ................ -1n --........ <br /> LEACHING LINE [ ) No. of Lines .. .....:........... Length of each line-10.................... Total Length .�_................ .....6 + <br /> 'D' box _)....... Type Filter Material ........Depth Filter Material .Zo.”l.......................... � 1 <br /> Distance to nearest: Well ..................... Foundation _--_----_-_---__ Property Line ........:.........-.-•-•4E I <br /> SEEP O Depth .................... Diameter ...........:.... Number ............................. Rock Filled -Yes ❑ No O <br /> Water Table Depth .............................. ................Rock Size ............................ . <br /> Distance to nearest: Well ...................... .............Foundation ............ Prop. Elne .................... <br /> REPAIR/ADDITION tPrev. Sonitation-Permit ........................................... Date ..............---------.._-------.) � o <br /> Septic Tank.(Spedfy Requirem_entsl - . .: .............�. ..............................................___......_.__...................._................ <br /> Disposal Field (Specify Requirements)�...: -a.. ._: . ......................................................................... .......................... .......... 1 , <br /> ' ----•---------- ......................... --- ................................Y _ ---._._............ --.........-------•"•....................... - . ............_......... a. .... ! <br /> .............................I....................................................................................._..----•--•••---..-.......... _........................................................ <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 Dick'. Home owner or lice" w: <br /> sed agents signdture 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' Compensation laws of California." <br /> Signed ...-�`�...c�. - �"" :� �"'.::. :.: . Owner <br /> rifle ...._... -------- <br /> (!f other than owner) r <br /> i <br /> FOR DEPART ENT USE ONLY. <br /> APPLICATION ACCEPTED.BY .. � ....,-DATE <br /> BUILDING PERMIT ISSUED .................... ..............................................................................DATE ..................... ,. .._.._....... .... <br /> ADDITIONAL COMMENTS ...... <br /> ......................................................"•"- •-"................ :_ -... ....._...._..---...........--".......:. ....._..............._........................._.... �. <br /> f•-•---. -•----_.... _ ........................... <br /> Final Inspection bC ..................................Date ..... . ..... ...... <br /> EH 13 2h 1--68 Rev. 5m JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3H <br />