Laserfiche WebLink
.. FOR OFF'% I`1SE APPUCATION FOR SANITATION PERMIT -7 -2./J/ <br /> ........ = -JU—�►piete in Triplicate) Permit No. <br /> .......................................................... _ _ .Date issued r <br /> ... This Permit Expires.9 Year From Date Issued i <br /> Application Is hereby evade to the San Joaquin Local Health District for a permit to construct and install the work herein . i <br /> described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations$ <br /> J08 ADDRESS/L fON . 'f� :Y!: '. .......-./��..... .. .......... ...............CENSUS TRACT .................... .... <br /> Owner's Name ........................... ... ... .................................:.....Phone . . . �. f...... <br /> Address =b=•--- .... .......•._ .............................•----.....- .City ...... .............................. ...._............... <br /> Contractor's Name ...:(��--• � ......-..license" #����' "• one <br /> Installation will serve: dente partment Housed Commercial❑Trailer Court 0 <br /> Motel (I Other..............................•--•......... <br /> . <br /> Number of living units:l----------- Number of bedrooms •`._...Garbage Grinder ............ Lot Size .............................. . .... ...... r rt <br />� . <br /> Water Supply: Public System and name ..........................:. .._... ....__..........._......._..........................................Private In <br /> Character of soil to a depth of 3 feet: Sand® Silt(> Clay 0 Peat p Sandy Loam ❑ Clay Loam ] <br /> F f <br /> Hardpan❑ Adobe❑ Fill Material ............If yes,type............... ............ ' <br /> (Plot plon,-showing,size,of lot, location of system'In relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW iNSTALLAYION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r <br /> .............. Liquid Depth . ... 0 <br /> � PACKAGE TREATMENT .( ] SEPTIC TANK J ] ' .. Size... ............................ - q p ...__... .............� <br /> € Capacity �' e ._��.-..... .Material..... - Na. Compartments -- - --••-.. <br /> ..Foundation .. Prop. Line <br /> €- Distance to nearest: Wel! ___� �....................... .... P• --...�....._...... <br /> LEACHING LINE [ ) No. of Lines • ................ Length of each line.. .........-.•.... Total length ................ <br /> - `D' Sox .:1.---.---- Type Filter Material ...Depth Filter Material .�.�..._.•..'.............:... <br /> .F ...r <br /> Distance to nearest�Well#•.........•.._..•..___-_, eundation ........................:• Property LMs N <br /> .__. <br /> ' SEEPAGE PIT I ], Depth ................... <br /> _ Diameter Number Rock Filled Ye; ❑ o <br /> t Water Table Depth ------------- ..................................Rock Size .............A.......... <br /> _....... <br /> Distance to nearest: Well ___-_•...---•...........................Foundation ..................... Prop. Une ..........-........ <br /> REPAIR/ADDITION(Pray. Sanitation Permit# ............................................ Date ........_----------------- <br /> -• ._...) <br /> Septic Tank !Specify Requirements) .............. :.................. - .......,.......... ............. - ............... <br /> Disposal Field (Specify,Requirements) .....................................................................:....•-•-----......__.....-----...I...........' <br /> ............ ! ----•----•- •--••----•..`- ----------------••-. -•--•- . -�...�1.---:.... ...._..._.............__..............-•-•- ............ ............. <br /> �`_ :. ..................... .. .... ..... ............•..-............................ <br /> ...................... . ...................•----...--..........=---...._.......... -- ,_, <br /> ' (Draw existing and required addition on reverse side) <br /> 1 hereby certify that'I have prepared"dils application and•that.-the.work,will-.%q done in accordance with Sae► ,Ipaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin lata!Health District. Henle 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 Persalt In such ma�n/ner <br /> as to be: COM subject to orkman' Compensation laws of California." <br /> [T" <br /> Signed ---- -,_ �..... ._ ..... .............................................•-•----••-.. Owner <br /> ... 71tIe ........................................................................ 4 <br /> By ................................................................................................•--• i <br /> Of other than owner) <br /> FOR DEOARTMENT USE ONLY <br /> l /� <br /> E APPLICATION ACCEPTED 13Y .. .....,DATE.w.;-7.. ...:...:.........'...: <br /> BUILDING PERMIT ISSUED ........DATE •..............••••••••,--•• ............. <br /> ADDITIONAL COMMENTS ..............................................1..._._.... ...... <br /> ..................................... .................................................--...........------. . <br /> Final Inspection by: Date .... .-�..�� .. ............... .. <br /> EI 13 24 1-68 Rev• 5H SAN JOAQUIN LOCAL HEALTH ICT 8/711 3M <br />