Laserfiche WebLink
FOR OFFICE USE:----=------------------------- <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No: <br /> (Complete in Triplicate) <br /> ----------I - <br /> - <br /> ------------------------------------------=- <br /> ___._-_---------------` This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made'to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County O dinance No. 549 and existing Rules and Regulations: <br /> J08 ADDRESS/LOCATION -'-_�_ _ _.__ --1 '` ---------- ---------=--r------------- ------ ENSUS TRACT ----� - s-----•___. <br /> d ' <br /> Owner's e _ - -- ----- ------- ------- ---Phe -------------------------------- <br /> Address - 4 ----------------------------- <br /> Cit --- -------- <br /> Contractor's Name --------- - _ -- ----------- - ---- ------ - ' - -.License # J113 hone ------------------------------ <br /> Installation will serve: Residence Apartment House�❑ Commercial ❑Trailer Court i[] li <br /> i Motel F1 Other ----- -------------------------------------- <br /> Number of living units:- f_------- Number of bedrooms _7-1_',�- _Garba_ge Grinder ------------ Lot Size ____________________________________________ <br /> Water Supply: Public System and name ___________________ _________Private A <br /> ------------------------------------------------------------------------ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ rClay ❑ Peat❑ Sandy Loam Clay LoamE] <br /> Hardpan ❑ 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.) W <br /> NEW INSTALLATION: (No'septic tank or seepage pit permitted if public sewer is avdilable within 200 feet,) <br /> PACKAGE TREATMENT I I SEPTIC.TANK'[ I Size------------------------------------------------ Liquid Depth . <br /> C <br /> Capacity ------ a__P, --= Type -------------------- Material---------------------- No. Compartments ------------_------• L <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- <br /> LEACHING LINE [ J Nb.`-of.Lines _-.,_______i__ Length-cfe_ach,line_---------------------------- Total Length ___________________________ <br /> 'D' Box .-_---- ---- Type Filter Material --------------------Depth Filter Material ______________-_______________--.--__-____.- <br /> Distance to nearest:'Well -.L____ __________ Fouhdation ------------------------ Property Line ----..-.________-------- <br /> Sf EPAGE PIT [ ] Depth -------:._— Diameter ..*_________--- Number __________________________ Rock Filled Yes C] No .❑ <br /> Water Table Depth ------------------------------i4y-----.- Rock Size -------------------------------- <br /> Distance to nearest: Well ____________________ __________ _______Foundation __________________ Prop. Line ------------I......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------..--------------------------) <br /> Septic Tank (Specify Requirements) -------- ----------------------- .__ - �"� <br /> /'� Q --- <br /> Disposal Field (Specify Requirement ----&lee `_.-- 1` -------------------- --------------- <br /> --------- <br /> -------------- <br /> ---------0-------------------- --- ----- ----- -. -------------` ---------rte ------- - ------------------------- <br /> i <br /> (Draw existing and required addition on reverse side) <br /> 1 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..Ru les-and-Regulations--of-:the San-Joaquin--Local. Health-District.-Home owner or licen- <br /> sed agents signature certifies the following:. I <br /> "I certify that in the performance oUthe.work for which.this permit.is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California."' :t <br /> ,' v .. 1 <br /> Signed ---- ------------------------------------------------ <br /> Owner <br /> By --------- ----- ------------------------------------------- - - Title --- '` ----------------- ------------------ <br /> [If other than'`owner) <br /> ,FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------------------------------------------------- DATE ----------- <br /> BUILDING PERMIT ISSUED ------------------------ -----------------------------------------------------------------------------_-DATE - --------------------------------------- <br /> ADDITIONALCOMMENTS --------------------------------------------------------------- ------------------------------------------------------------------ -------- -•---------------- <br /> --------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------ ------------- <br /> --------------------------------- -------------------- - - --------------- ------ ----------- - ---- <br /> - t--- ---------- ------- <br /> Final Inspection by: -----.Date _-2 ------------------ <br /> - - ---- -- - - - ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />