Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
r FOR OOFFUSE= <br /> ICE APPLICATION FOR SANITATION PERMIT permit Mo. .. �'•=��3 <br /> ............................................. Ito mpfotin Triplicate} <br /> _ .. ..- _ Date issued . <br /> 6- <br /> This Permit Expires i Year from Date Issued <br /> " <br /> Application is hereby made to the San Joaquin local Health District for a permit to constnitt and install the work herein <br /> described. This application is made In compliance with County ordinance No. 549 and existing Rules and Regulationso ; <br /> CT <br /> � �� �� . ' ...... .... .....................C..ENSUS TRA .......................... <br /> � <br /> ; <br /> . .. :. � <br /> JOB.'ADDRESS/ OCATtO� � . ...`�. /.f.... ..... <br /> ....Phone <br /> Owner's Name ...... ...............t City .....- es� "..................................... <br /> Address ...... ......_..... t. ...............License # ........................ Phone .............................. <br /> Contractor's Name <br /> al❑Trailer Court (:3 <br /> lnstallatiqf.willservih Residence Apartment House 0 Commerd <br />{ �' Y Motel ❑Other---•- ...... .............•----...... GI <br /> E ��p -_Garbage Grinder ............ Lot Size .. - <br /> Number laving un�Y . Number of bedrooms <br /> ...................................Prhwta <br /> Water Supply= Public System and name .................------------------------............ <br /> --- ....._....... � <br /> i Character of soil to a depth of 3 feet= Sand E3Silt C3 Clay (:I peat E3 Sandy Loam❑ Clay Loam , <br /> Hardpan❑ Adobe 0 Fill Material ............If yet................. ............ ' <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 if public sewer is available within 200 feet.) <br /> PACKAGE 'TREATMENT [ ] SEPTIC TANK Size... ..... .......' <br /> Liquid Depth_........................ <br /> ................. <br /> . .MaterIal. Lam.:.. No. Compartments . . �-. ..... <br /> Capacity Type .. . - - <br /> . f ...........Foundation .4� _ ...........Prop. Line . ... <br /> t .57 <br /> Distance to nearest= Well ._. _ / <br /> Length of each line. ... ......... Total length .. .� <br /> LEACHING LINE No. of Lines /� - <br /> I •D' Box .....�.... Typs liter MoterloI <-444�epth liter Material ...... .. .. .......... <br /> Foundation Property Une . . ......:........ <br /> Distance to nearest= Well ....4 .. <br /> J h Diameter ................ Number ............................ Rock Felled Yes ❑ No ❑ <br /> SEEPAGE PIT I ) Dept ...........---...... <br /> ^� Water`Table Depth ................................................Rock Size ................................ <br /> ndation ............ ....... Prop. line ..........,.....--- <br /> Distance to nearestt Well ........................................Fou .� <br /> REPAIR/ADDITION►Prov. Sanitation Permit 0 ............................................ <br /> Data .---..............................] <br /> Septic Tank (Specify Requirements) .................................. . ... . .....-- ..... .. .... .............. ...... .......w <br /> .. .............. <br /> Disnosal Field (Specify Requirements) ............................................... ...._..-............ <br /> 71 <br /> k 1. <br /> .............................. <br /> .............................. <br /> ....I.......__.. . .._....__. ....... '.:.......................................................•................................. <br /> . ............ <br /> - .. ..odi -- • re prepared this application and that the work.will be dons in actsrdants with San Joe <br /> (Draw existing and required addition on reverse side) grid <br /> hereby certify that ! have p p PP <br /> County Ordinances, State taws, and Rules and Regulations of the San Joaquin Local Health District.Home owner or scam' <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 net employ any person In such manner <br /> as to becoV,,,oc,.,o orkman`s Compen do - aws of California." <br /> 5. nedJh <br /> ...................... Owner <br /> g . . <br /> ---- -•-••......................... <br /> title .....:.. ......... <br /> t (if other than ownedr <br /> h <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ... . ................ <br /> DATE ... <br /> BUILDING PERMIT ISSUED �...... ........ AT ..... <br /> ...;'- ..................... <br /> f ADDITIONAL COMMENTS .... <br /> ... ..... ............................ <br /> ---•--------•---------------------. ...... <br /> ..............------•-. rK -. <br /> . ...................... . ... . .... <br /> ........... <br /> .. <br /> .. ------ ---- ------ - - --- Date ..-. <br /> Final inspection isy: .-... ------� -- -- .- .. .. ., ............ . . . <br /> EH 13 2h 1-60 v. SAN JOAQUIN LOCAL Hid LTH DISTRICT 8�7 <br />