Laserfiche WebLink
.FOR OFFICE USE: <br /> --------- --------_1------------------­ ------ ------- APPLICATION FOR SANITATION PERMIT <br /> -------------------------------------------------------- (Complete in Triplicate) Permit No. <br /> . -------------•----------••---. ---------------- This Permit Expires I Year From Date Issued Date Issued <br /> Application is hereby made to the S <br /> an Joauin Local Hea ()istrict for a permit to construct and install the work herein <br /> described. This application is made in compliance wi h Co A�% dinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIO <br /> ...CENSUS TRACT <br /> 70 <br /> Owner's Name ...... <br /> --- ---A... ............. one .... <br /> Address ...... ..... ------ <br /> ................................ <br /> _-1.................. <br /> ........................X <br /> Ply -------- <br /> Contractor's Name <br /> ........... <br /> Installation will serve: Residenc ... ......... ..................... I�icense # --- -------------------- Phone .............................. <br /> pa ment House C] Commercial E]Trailer Court 12 <br /> Number of living otel El Ot er L................................---------- <br /> units:.--/------ N I mber of bedrooms --- Garbage Grinder L- --------- Lot Size --------- <br /> Water Supply: Public SyA nd name ....... <br /> ------J------------- ------------------ ........... <br /> Character of soil t, ----------- ------------------------------------Privat <br /> ;mor feet: Sand'0 Silt 0 Cl Pea EJ Sandy Loam Ep- Clay LoamX <br /> Hardpan E] Ma* terial ------------ If yes, type .............. <br /> .............. <br /> (Plot plan, s ing size of lot, location of system in r I ion't we s, buildings, etc. must be placed on reverse side.) <br /> NEW IN ON. <br /> NEW INV ILLATION: (No septic tank or seepage pit .,ed if publi sewer i�available within 200 feet,) <br /> P p <br /> _tACKAGE TREATMENT SEPTIC TANK <br /> 71 ............. Liquid Depth .....-:Tptj..r <br /> .... .. .... . <br /> Capacity Material --- No. - ------------ <br /> Compartments ---- <br /> . ............ <br /> Distance to nearest. R <br /> ---- _____________Foundation _._/0.-#--------- Prop. Line ........ <br /> LEACHING LINE No. of Lines ------.. .... ch ne---- -/N---'To• tal • <br /> Length ,4� <br /> 'D' Box --____ti Type Filter Mater` <br /> ----.Depth Filter Material .... . <br /> ............................... <br /> __.t•. <br /> Distance to nearest: Well .. tof 0 <br /> # tOn—------------------------ Property Line C. .............. <br /> SEEPAGE PIT Depth __2,W---------- Diamete <br /> ..... Mber .... ... <br /> ------------ Rock Filled Yes No 0 <br /> Water Table PJ W--------------------------____________________Roc Size <br /> Dis once to nearist: Well ---------.. ..... ..",I I '., f <br /> ... ............Fou dation -------fA------ Prop. Line _..;c-----_----- <br /> REPAIR/ADDITION(Prev. S nifati V ern it# ------------------------------ ----- - ------- Date --------- <br /> Septic Tank (Specify Req iremeng) --- ---------------------------------------- <br /> Disposal Field (Specifyequirement 4,;" <br /> lik <br /> ----------------- ---------------------------------------------------- .................. <br /> ----------- ---------------­------------ ................... 0................. ........... ------------ ----------------------------------------- ----------­--- <br /> - ---- -- --- ---- -- ----- <br /> (Draw ---- <br /> existing and required addition--a-n.-reverse-side)-------L---------L----------------------------------------- <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 subject to Workman's Compensation laws of California." <br /> Signed -------------------------- ............ ....... - ------------------------------------ Owner <br /> By <br /> ------------------------ <br /> A <br /> , I ......... Title - ---------- <br /> atah owner) .......... . . . . ...... ... ............ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- ------------- -------- - - ---------L........ -- ---- DATE <br /> ADDITIONAL COMMENTS <br /> BUILDING PERMIT ISSUED . <br /> ......o�,� ----------------- ------ <br /> ,y---;1-----------:.:DATE� . ........ .............. <br /> I--------- -- ---/---------- <br /> .......... .. --------------------- --------------Z . ................... ----------------­---------L------------- <br /> .. ...... ... ................. --------- ................. <br /> ...................... <br /> - ---- ---- - - <br /> ----- - ------- <br /> ------------------------- <br /> Final Inspection by ------ <br /> ------------------------------------ ....... <br /> ..------------•--•- - ate <br /> �OW OA65IN L5UL HEALTH'h_1_S_TRFff ;Ilk <br />