Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT y, <br /> --------------------- --- - Permit No: .--l. -~ - <br /> (Complete in Triplicate) <br /> .__Y This Permit Expires 1 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/ <br /> VN5'? <br /> pf pY�_ <br /> . - -__-_-_ ------------------- .e--- --_. ----- TRACT <br /> ----- <br /> I <br /> ------------------------ <br /> Owner's Name Phone <br /> Address - - <br /> Contractor's Name--- - - -- ----- ----- -=----License # IW312 <br /> 1_ Phone ------------ -• --••--•------- <br /> InstaIlotion will serve- Residnt Apartment House Commercial ❑Trailer Court ❑ <br /> Motel ❑ Other,------------------------------------------- <br /> Number of living units:- Number of bedrooms 3---_--Garbage Grinder _.---------- Lot Size __l.L- - - ....--- <br /> Water Supply: Public System and name ---------------------------------------------------------------------------------------- ---------------------PrivateA <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <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.) <br /> NEW INSTALLATION: (No septic tank or seepage 'pit permitted if public sewer is available within 240 feet,! ] <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ] i Size---_------------------------------------- ---- Liquid Depth .------_-.----.---..------ <br /> Capaci#Y ----------------•- TYPes-------------------- Material---------------------- No. Compartments ------ ----------..... <br /> � <br /> Distance to nearest: Well:------------------------------------Foundation ---------------------- Prop. Line ----------.--_-------�1 <br /> LEACHING LINE [ ) No. of Lines ------------------------ Length of each line---------------------------- Total Length _-----.-_-------_---..---.--J <br /> 'D' Box ------ Type Filter Material -_-----------------Depth Filter Material _------------__--------_---_---_------.---. <br /> Distance to nearest: Well ------------------------ Foundation ------------- --------- Property Line, --------.----.-._-.----- <br /> SEEPAGE PIT [ ] Depth ____________________ Diameter -----------.-- -.---------- Rock Filled Yes C <br /> -- Number --.-------------- ❑ No <br /> Wafter Table Depth ------ ------- -------------------------------Rock Size ---------------------------•---- <br /> Distance to nearest: Weil ----------------------------------------Foundation --------------------- Prop. Line --------------..------ <br /> 3 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------I <br /> Septic Tank (Specify Requirements] ---------------------- ----a--------------------------- ------------ --- <br /> Disposal Field (Specify Requirements) - - -yrs'-- --------- ------ -- - ----- ----- '� ---- �- <br /> / s <br /> =�=-- -------- ---------- -�- -------- <br /> G <br /> "G <br /> - ---g 3required.X 2- ---------- <br /> (D existing and additi 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 subject to W rkman's Compensation laws of California." <br /> Signed --------- ------- _ Owner <br /> BY ------ ---fi--- Title _ - <br /> ----- ----------- - ---------------- <br /> (if o#h n owner] <br /> ot EOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------------- DATE . d `� -r3----------.-_--- <br /> BUILDING PERMIT ISSUED ------------------------------------------ -------------------------------- <br /> --- --------------------------DATE --------------------------------------- <br /> ADDITIONALCOMMENTS ------------------ -------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- ---------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------- ------------------- ---- <br /> DateJ - �•#f -------------------- <br /> -------------- <br /> ---------------------------------------- ----------------------- ---- - <br /> Final Inspection by: +. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />