Laserfiche WebLink
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE: <br /> APPLICATION FOR"SANITATION PERMIT <br /> �. -y..r...T � <br /> ........................... (Complete in Triplicate) Permit:No.� <br /> This Permit Expires i Year From Date Issued 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 rr <br /> /LOCATION <br /> ......... .... ...444 4----.........k'.'c jX.:.!�. ...CENSUS TRACT <br /> : 44.44 . 4444.-.._. 4444.... <br /> Owner's Name ................ <br /> - - - - 4444... 4444.----•-- <br /> /� �,, r �...............:...............Address ..................... �tco .......�CJ.�A_. Phone ;7 <br /> ...._..._. .. -----4444 f-•--4444 City �...���. <br /> r4444_ ����----- <br /> Contractor's Name ............. license # ... - ---- .. <br /> Phone .. d� <br /> - _ - <br /> Installation will serve: Residence %Apartment Housed Commercial oTraller Court Q <br /> Mote( ❑Other ........... <br /> Number of living units:__...__. Number of bedrooms ...f......Garbage Grinder_..._..._... lot Size ............. <br /> Water Supply: Public System and name .................. .... .. <br /> _.*... P <br /> ,� . .. .. ... ... rivate <br /> Character of soil to a depth of 3 feet: <br /> SandC] Silt❑. Clay-.[:] at, <br /> -•• Y O --Ile <br /> p�Sandy Loam fl. . Clay loam D.. <br /> Hardpan 0 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 /> I NEW INSTALLATION: (No septic tank orseepagepit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT <br /> r[ . SEPTIC TANK <br /> r I <br /> Size... <br /> 4444----•_:f:.�_. <br /> �- 1 f•�.. . ...................... Liquid Depth ...�-5.�•y-... <br /> Capacity .�Q '_.4444 T ' <br /> Ype ••-- --+ -:_ Materia]-..(' ....• No. Compartments <br /> tr4444 <br /> . _5-Q r i r e...:.... <br /> Dis#or:ceato nearest: Well <br /> `4444. - Foundation .....1 Q.- ..... Prop. Line <br /> ... 6 <br /> LEACHING LINE X No. of Lines �...... Length of each line.. <br /> t � r <br /> -�... - 1 <br />- � --•�----�.3.E. Tota Length f g <br /> 'D' Box. Type Filter Material � .�:.___•Depth Filter Material <br /> 4444_ y r ................... <br /> I <br /> Distance to nearest: Well ...:. .Q........'..:: Foundation /.--• <br /> Property Lime .. <br /> - ..... . O.�......._. <br /> SEEPAGE PIT [ j f Depth <br /> ... LDiameter .__---�' -•--. Number.......................... Rock Filled Yes p No Q <br /> Water Table'Depth•.....................--•---4444_......s.:......Rock Size .. <br /> ----4444...................... <br /> Distance to nearest: Wel( .4444__......... <br /> - Foundation <br /> ----••--.. Prop. Line <br /> ......................REPAIR/ADDITIONSanitation Pe_rmit�# <br /> (Prev.( ............,................... . Date -� <br /> Septic Tank (Specify Requirements) .....................44---4444.. , . _.._..... .] <br /> _ ------ <br /> _4444...-----•--•�---•---••--•- _. <br /> Disposal Field (Specify Requirements) <br /> ...........-__. :..c._..#44__44 ------- --- ----------------- -----------------•---•---••-•---- ...__.._..........._._....... <br /> ............ ------------------------------------- . - <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, i shall not employ any person in such manner _ <br /> as to become sub]ect.to Workman's Compensation laws of Californla." <br /> Signed ' <br /> --. •------•- <br /> •-- ---4444.. . 4 444. . . . <br /> . Owner, <br /> By IT <br /> (if other n owner <br /> F12k EWPARTMIENt,USE ONLY w ; <br /> APPLICATION ACCEPTED BY.... i h DAT <br /> BUILDING PERMIT 155UED ................•--__ <br /> T E <br /> • -- •. --• ......... .... <br /> ADDITIONAL COMMENTS DATE ...__.. i <br /> ...........::: : <br /> ............ ...... r <br /> ----•-...... •-- •....................... .. <br /> ........................................ 4444... 4444 .. <br /> Final Inspection b --- ------•- 4:444.. <br /> y: .._..... ......� .�_. . � 44.44---- <br /> •- ....--- . •--••.............Dat _ 4444 r <br /> SAN JOAQUIN. LOCAL.HEALTH DISTRICT <br /> E. H.1.3' 241-'68 R . :°:: <br />