Laserfiche WebLink
FOR `OFFICE USE, <br /> k eAPPLICATION FOR SANITATION PERMIT <br /> 7S— �o U <br /> i.._ ..._ ..... i................... Permit No. .. .......:._..... <br /> (Complete in Triplicate) <br /> Il This Permit Expires 1 Year From Date Issued Date Issued .7�� <br /> ` Applicotionl;lis hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> i described. This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: <br /> f IJOB ADDRESS/LOCATION � S....AQ,. _...._�._ .`- .. ���,,,,.�... _ CENSUS TRACT .......................... <br /> Owner's Nome ............ 11 ...... 0V,��----. Phone ...•-----•-•----------- . <br /> I ! w <br /> Address �+•t -_- City ............. <br /> Contractor's��Name .. .. - ? �,..- _ License # _...................... Phone __............... ...... <br /> will serve. Residence A_ partment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑ Other -- ----- ----------------------- <br /> Number of living units .... Number of bedrooms .�3.....Garbage Grinder Lot Size ..:.•. . ..._.. ....................... <br /> Water Supply: Public System and name ................. ................... -------- --•------ --------•-----------....----------•----------...Private ®� <br /> !i <br /> Character of,soiI to a depth of 3 feet: Sand Silf❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam <br /> I Hardpan E] Adobe ❑ Fill Material ...... _._ If yes, type ...... .... .............. . <br /> (Plot plan, showing size of lotlocationrof system,in relation to wells, buildings, etc. must be placed on reverse side.) , 1 <br /> A�� -- I" <br /> NEW INSTALLATION: INo septic tank or seepa pit permitted if public sewer is-available within 200 feet,) <br /> PACKAGE TREATMENT _ <br /> I REATMENT [ ] SEPTIC TANK�( Size....................:.. :.-•-"-"�'--•�.--�`.__-Liquid-Depth .............-------------- <br /> Capacity ... Type '_._..... Material-.4o— No. Compartments _...__ '........ 0 <br /> Distance 'to nearest: Well ____________________Foundation .. ..._ _. ........ Prop. Line .......... --J <br /> k LEACHING LINE [ ] No.' of Lines Length of each line................. ..... .... Total Length <br /> 'D' Box �Y&?- Type Filter Material40 ! :Depth Filter Material .....`��................................ <br /> Distance to nearest: Well Founcidtion __;;W.... <br /> .------ <br /> .. Property Line .................. ___ <br /> SEEPAGE PIT Depth Diameter ..__-_-._-_--. Number 7............. Rock Filled Yes 0 No <br /> I r <br /> Water Table Depth -----------•----------•-- --•---- .............:Rock Size ........ •............ ..:.... <br /> I <br /> Prop. Line ----_-------=-------- <br /> � Distance to nearest: Well ......................:.................Foundation _--_.....-. 9 <br /> ,I .. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------•Date ...•-----•--•---._.-.._._._....... <br /> ) <br /> Septic Tank (Specify Requirements) .................... . ....... --- -.._-- --------. ----- •----------- ---------.... -•--•-•--. ....... ....... <br /> .._...... � <br /> Disposal Field (Specify Requirements) -------------------- --------------------- <br /> -------------- ----------------------- ,. ..,i. ...------------.--------------------------- ----- .. -- ....... <br /> _-.-_____...........:..... _ ................................ ------------ . .- -_...-__._. ___. .._..-_------ ..- _-------.-------.............. <br /> (Draw existing and required addition on reverse side)_ _• r <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 bec sub'ect t or man's Compensation laws of California. <br /> Signed . <br /> ,ZZ <br /> _ .. ---------- Owner <br /> ) <br /> By ... .............. -_.... ........ Title . .... <br /> (If other than owner} <br /> _ I FOR DEPARTMENT .USE ONLY , <br /> APPLICATION ACCEPTED BY `6 J C ✓................. DATE ...... .".1... �. �*--..._._ <br /> BUILDING PERMIT ISSUED ...........:...................... DATE _ ........................... <br /> ADDITIONAL' COMMENTS .. ........:.... ... ..........................................I.........,;<_; _ -...........................................................:. <br /> I�- --- <br /> ------•--- ----------------------- ------- ------------------------------------------- -----• ................ __-- -------:. ---. <br /> k i <br /> Final Inspection------------------------------------------------ •....._..--- :._;.:..._--_-- --_.....-._.- ---_-I........ <br /> p �L_.....__ .. ---- ------------------------ --------------- <br /> x: _.Date ... :._I_ <br /> by: .............. 0 I... j ._..------------------------------------- ..�.. --� ------------ <br /> SAN JOAQUIN L6CAL HEALTH DISTRICT <br /> t u 13 24 1_'AD Da., FAA _ 7172 3 H <br />