Laserfiche WebLink
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT <br /> Permit lslo. ,IZ:�7 <br /> (Complete In Triplllcato)_ ...... <br /> ............................. ......... -q,�7 <br /> Date issued _7 <br /> .............. ....... .............. This Permit Expires I Year from Date Issued <br /> Aplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the workherein <br /> depscribed. this application is mad in compliance with County Ordinance No. 549 and existing Rules and Regulations- <br /> JOB ADDRESS/LO TION S-1-D-0.........st.../Ot4m(........ ..............-....... ....CENSUS TRACT .......................... <br /> Owner's Name -----P_I_C,r .......................... ............r.....................Phone .................. ----------- <br /> ...................... <br /> - --------- ------- ...... ......­­...... <br /> Address .......3-4, A_.... .......-......... ............ city <br /> Contractor's Nome ... -11.--•------------------.--....License # <br /> Installation will seidence jP Apartment Housefl serve: Re Commercial oTraller Court E] <br /> Motel []Other ............................................. <br /> Number of living units ..... Number of bedrooms .-q......Gorbqge Grinder ............. Lot Size ..Zt.? <br /> Water Supply: Public System and name ......... ...................................................................................................Private-W <br /> f i <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 1:1 Clay 0 peat 0 Sandy Loom 0 Clay Loom <br /> Hardpan Ej Adobe 0 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 200 feet,) <br /> PACKAGE TREATMENT SEPTIC tANKA .-----...-•--..._... Liquid. Depth ............... <br /> Capacity ... Type .. Material.... ......... No. Compartments .....; ....... ..... <br /> ......... <br /> Distance to nearest: Well _Z�0 - <br /> ........................Foundation ............. Prop. Line ...F__ <br /> k - ----- ........... Length of each line... ............... Total Length ........ <br /> LEACHING LINE No. of Lin'es <br /> . . <br /> V Box ace---- Type filter Material .........Depth- Filter .Material ................... ............ <br /> ......... ...... Property Line ..ir.................. <br /> Distance to nearest: Well ........... foundation'' <br /> Depth --- .......... Diameter No 0 <br /> "Number .................. Rock Filled Yes <br /> Water .Table Depth' --------------Rock Size ........... ...... <br /> .. <br /> Distance to nearest. Well .1.4.0...............................foundation ...4............... Prop. Lin ... .......... <br /> I . <br /> REPAIR/ADDITION1Prev. Sanitation Permit# .._.._...---.----....---•--......•.......... Date .............................. <br /> I .....:.........................�L.........-4....... ....................—.......................... <br /> Septic Tank (Specify Requirements) ---------L -------­-­------------ <br /> --------------------------------- <br /> Disposal Field (Specify Requireiments) ---- -----------------------------------------------..-....--------------•--••------------ <br /> ------------------ _............... ....................................­­­­......... ............ . <br /> -------------------------------------- <br /> 1 11 . ......—... ............... <br /> ------------------------------------ ----------------------------- ------ -------------- ------------ ....---------.._._.........._.......-•-•--.. .. ...................... <br /> I (Draw existing­and-Wq-u1 re-d-d-dd 1tivn-`b1ViCverse 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 Son Joaquin local Health,Distrid. Nome owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify tho in—=_ erForm nit the ork for which this permit is issued, I shall not employ any-person In such manner <br /> k a e <br /> as to beco e subje!�A* Workm in Co e1V%c=n lawsof California." <br /> ------------ Owner <br /> Signe - _- ---------------I ------ ----_------------------ <br /> By --------- -------------------------i--- -------- --------- ------ --------------------- 'Title ­­........­............... ............................ ......... <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- ..............I——------------------- -------- ... ............. <br /> BUILDINGPERMIT ISSUED ---------J........ --------------------------------------------•L ..----..-._._--------DATE ....... ---------------------------------- <br /> .............. ..........................................I....... <br /> ADDITIONAL COMMENTS ------------ ••----•-------------- ................ ---------- .............. <br /> ............ ----------------------__----------- ----------------------­- -------------------------------------------- .......... -----•..--•--- ...... • ------ <br /> ------ ----------------1................... <br /> -------------------­-- <br /> ------------------------------------- ---------------------------11--------11-11------ <br /> ------------------- -------- . .....1-1----------_---_ ---------- ........... ----------------­­ -7 �------------------------ <br /> ............... <br /> FinalInspection by: .........I-------------------------------------------------------------- Dater, 7.......... <br /> EH 13 24 1-68 Rev. 5M' I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />