Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------- .................... Permit No;�) <br /> (Complete in Triplicate) <br /> .._.......•-----•........ - - ----- This Permit Expires 1 Year From Date Issued Date Issued-_S.`-�"7� <br /> ... � <br /> ..................... ........... ......... <br /> .. ........... <br /> Application is hereby made to-the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance,with County Ordina ce No..544 and existing Rules and Regulations; <br /> ti.... CENSUS TRACT.-.--- ...._.. ---- <br /> JOB ADDRESS/LOCAT ..."/ D .. <br /> ----------- ..Phone �/.:. <br /> Owner's Name - --- ... ---- - --.. . . _.._. ._.- --.. <br /> 17 <br /> Address...... .. ... City ziP------- --------------- ---- <br /> --- --------- �..Y _...- <br /> License #_ .rO <br /> Contractor's Name.-- --......Phone_. �Q <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other----. ------------------------ <br /> 91 <br /> --- ----------------- ,r <br /> Number of living units:.--.)/-Number of bedrooms.._.�...Garbage Grinder.-.----..__Lot Size.-d.-•�."�- - .----. �------- --. -- <br /> Water Supply: Public System and name-- ._... - ........-1--------- -------- ................ -----..--Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ r <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 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ( Size..L`.lo+.JC_ � -_------ ---------Liquid Depth..- v <br /> Capacity. -------Type: i�A Material <br /> --. .--._...No. Compartments------------ "'-- -----. <br /> c <br /> Distance to nearest: Well_....- -----------------Foundation-_._ .+� -....-.-- -. Prop. Line- ._- ------ <br /> Length of each line.. .-- .-.._._....Total Length ._ _ �..-_------- ----------- <br /> LEACHING LINE (tj No, of Lines....--.-,9_-__-__--__-. <br /> 'D' Box....-` .- Type Filter Material-J6. xA--`.Depth Filter Material..-. ...�-f�_-_-_------------------------------- ------ <br /> Distance to nearest: Well...... <br /> Foundation----�-- ----------------Property Line... ..----------------...------- <br /> #�''��', <br /> SEEPAGE PIT (+ Depth_vl�._._..Diameter_-_-_ ��._-.--..Number....------�---------------- Rock Filled Yes �# Na <br /> r <br /> Water Table Depth------------14------- - ---------------------------Rock Size.__... x�... <br /> � r <br /> Distance-to nearest: Well....... -................Foundation_. Prop. Lin.-.-.,5 ---------- <br /> REPAIR/ADDITICIN (Prev. Sanitation Permit#--------------------------_- --------- --Date----------••----_----- ------=-----------� <br /> Septic Tank (Specify Requirements).....- ... • _------------- <br /> Disposal Field (Specify Requirements)---- ------------ .---- <br /> -----•---------- ----------------------------- ---------.. •--......._-......... <br /> (Draw existing and required addition 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 County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> t "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become subject tork an'syCamp nsation laws of California." <br /> Signed------ M �-.' ./ .. .....--:; <br /> By------ -- Owner <br /> ---------_------ � -� Title-- <br /> (If other than owner[ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- ---- DATE -----5.'_3-1- ------------ - ------•-- <br /> DIVISIONOF LAND NUMBER.------ --- ------------------------------ --------------------- =----------DATE.------ --------------- ..-._...-- ---- <br />' ADDITIONAL COMMENTS--------------- ------ ----- ---------------- - --- . -- - -_... <br /> ----------------- --------------------------... ---...---------- --------- ...---... --- -- ---- <br /> -------------------- _g, ---------------------------- ------------- ---=........ . -- - <br /> - ------ ---Date. 5'1 <br /> Final Inspection by: -.,�x�--- ------ - --------------------^-------- -------------------------. ------------ ...:1. <br /> Ett 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M <br />