Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No.7 3-14 6_b <br /> ----------------- <br /> (Complete in Triplicate) <br /> ----- --------------------------- a VDate issued _ 3a--------------- <br /> This Permit Expires 1 Year From 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 existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ----- -------------------------------- ------------------------- --------CENSUS TRACT -------------------••----- <br /> Owner's Name ------------- -------------------------------------------------------------------- ---------- --------Phone ------------------------------ <br /> Address -------------------- --- ----l------------------------------ -------------------------------------------- City _=---�1CA�y------------------------------------------•- -•---- <br /> Contractor's Name ----�"!,_ �-7( �_k------------------------------------------------License #�2 :_� --- Phone ------------------------------ <br /> I <br /> Installation vvj�..serves:.,.,. ResLdence,.❑_AparJ.merit.House[] Commercial :[]Trailer.Court ;❑��T <br /> SMotel ❑Other ------------ <br /> ( %9c2i <br /> Number of living units:_.__________ Number of bedrooms ____________Garbage Grinder ____.______ Lot Size ____._ _-------�_- -------•-- <br /> Water Supply: Public System and name ------------ --------------------- -----------•------------------------------ ---------•-----------•---------Priv ate ❑ <br /> Character of soil to a depth of 3 feet; Sand'❑ Sift❑ Clay J� Peat❑ Sandy Loam ❑ Clay Loam ❑� <br /> Hardpan ❑ Adobe '❑ Fill Material ------------ If yes, type ---------------------------- <br /> (Plot plan, s�owing size of loft, location of system in relation to wells: buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septicitank or seepage pit permitted if public sewer is available within 200 feet,} <br /> • <br /> PACKAGE TREATMENT SEPTfdtTANK f Size v----- -------- Liquid Depth �__�_1___ <br /> __ <br /> Capacity -19----,--- Type 6S!5L_Material---------------------- <br /> No. Compartments --�------•---•--- <br /> Distance ttinearest: Well /1 --------------------------- p .------•-- -------- <br /> _ Foundation ________________ __ __ Pro Line .._, <br /> t Len '© ------------ <br /> LEACHING LINE [ ] No. of Lines _--_ ----------------- Length of each line -��__ _____________ Total Length ____-�_- t <br /> 'D' Box ----0441 Type Filter Material --------------------Depth Filter Material ---------------- ------------- --- <br /> ti4, Distance to nearest: Well _______________________ Foundation Property Line ________. <br /> ...---•------• <br /> 4yy . , r <br /> SEEPAGE PITT [ I Depth -__ t____________ Diameter ________________ Number .-- ----.__.____---__-_____ Rock Filled Yes ❑ No C1 <br /> WateTfableDepth ------------------------------------------------Rock Size -------------------------------- <br /> D.istarice-qto�nearest: Well ----------------------------------------Foundation ------ Prop. Line _...--------------- <br /> REPAIR./ADDITION(Prev. Sanitation Permit# ________ ------------------------------------------------------ Date ------------------- --------------j <br /> ------------------ <br /> Septic TaA (Specify Requirements) _ <br /> I I <br /> Disposal Field (Specify Requirements) -----------•----------------------------------------------------------------------------------------------------- �1 <br /> ( *� ---------------- <br /> ------------ <br /> { ------------------------- <br /> ------------------- <br /> --------------------'---------------------------- --------------_��­------------------ =----------------•--------= ----------------------------------------- ------------ <br /> (Draw <br /> ----------(Draw existi.Ing and required addition on reverse side) fi <br /> I hereby certify that I have prepared this application and that the work vJill be done in accordance with San Joaquin <br /> County Ordiiances, State Laws, and Rules and) Regulations of the San Joaquin Local Health District. Home owner or Licen- <br /> sed agents s gnature certifies the following: i I I I <br /> "I certify that in the performance of the work-fbr-whick-this-permit`is-'tss-ued-lt-shall not employ any person in uch manner <br /> as to becomi subject o rkm�yann"s Compensation laws of California." <br /> Signed .--- - Owner <br /> ! 1 <br /> ------ Title ------------------------- <br /> -_(.1f other..than-owner-}. � ---_---- - ---- -`- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED. BY ---------- ------------------------ ---------------------------------------------------------------- DATE ----------I------------------------------- <br /> BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------- --------------DATE - ---"------------------------- - <br /> ADDITIONALCOMMENTS --------- ----------------------------------------------------------------- ----------------------------------- •-----------------• <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> _ __ . - --- - - - Date _. __0 __��3 ----------------- <br /> Final inspection by- ------------------------------ -------------------------------------------•------- - <br /> SAN JOAQUIN LOCAL NE -LT DISTRICT <br /> E. H. 9 .1-'68 Rev. 5M ti <br />