Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> - "` Permit No. .____--__-----• <br /> 1 <br /> ------------------------------------------------- f; :Complete in Triplicate? --- <br /> 70 <br /> Date Issued -91________ <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to th'e San Joaquin Local Health District for a per 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 /> r} P -•----------- -- CENSUS TRACT ---------------------- <br /> JOB ADDRESS/LO TION .__�_.�__�a�-7?--/ ----- ---------- E-- �r�---------- - <br /> ;�,,�U_ -- ---------------Phone ------------------------------•----- <br /> Owner's Name .fCx?�' - ' -� �'-�''-'-'-----------------------------•------------- ----- <br /> - --- ------ <br /> - Cit c------------------------------------------------------- <br /> Address ------I�--�J- - ----- ----- -' - - ---- -I----- - - Y - <br /> Name -- Cdr.._' --e-r-- -------- License # _1_$- �--_ Phone -------------------- <br /> Contractor'sInstallation will serve: Residence [6partment House-[] Commercial ❑Trailer Court ',❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units:-.-----I--- Number of bedrooms _- _,:__Garbage Grinder ____----__._ Lot Size --------t---------------------*------- <br /> - a <br /> Water Supply. Public System and name -----------------------------------------------------------------------------------------•---------- Private <br /> r <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [�Cla; Loam 0 16 <br /> Hardpan ❑ Adobe-F1Fill Material _- -__- if yes, type ---------------------------- <br /> (Plot plain, 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 seep ge pit permitted if pdblic sewer is available within 200 feet,] <br /> PACKAGE TREATMENT { ] SEPTIC TANK ! T Size_ <br /> ----------------- Liquid Liquid Depth --- ------------ --- <br /> I <br /> Capacity 70-- Ty Material_ ---- No. Compartments -. ------------- O <br /> _j r Foundation ___l- _--t Pro Line _C57 •------•-- <br /> ;Distance} to neare t: Well' -------------------------------- I p• <br /> LEACHING LINE [ �No.'If- ' ---- (length of-each line. ..............f-- Total Length--------------- <br /> D' Box -- .____-- Type Filter"Material`---�a12--------Depth Filter Material ---- --i-------------------------- <br /> Distance to nearest: ell;--ter- =--_-_-----__ Foundation <br /> N ndation -------I_r�---`--------- Property Line __--------------------- <br /> SEEPAGE PIT [ ] Depth __1----------- umber ---------------------------- Rock Filled Yes ❑ No i❑ N <br /> Water Table Depth -------Rock Size ------------------------------7- <br /> Distance to nearest: Well .............. ----------------- Foundatio — Prop. Line ____-_____------_-..- <br /> REPAIR/ADDITION(Prev. SanitaYon Permit# ---------------- ----- .,date ----._:. _------------------I , <br /> I <br /> Septic Tank (Specify Requirements) --------------------_ -------------------------------------------,--------------- <br /> T ,. . v. . .. __. <br /> Disposal Field (Specify Requirements) ___-___.___-- -, ----------------"--------------- <br /> - ---------------------------------------------------------------------------------- --- <br /> -------------------------------------------------------- <br /> -------------------------------------------- <br /> -------------------------------------- <br /> ---- •------ ----------------------- <br /> E , <br /> ---------------- - ----- --------------------------------------------------------1---------------------------------------------------------}---------------- <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 <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 /> Title ---------------------------------------- <br /> (If other than owner) ! <br /> `l FOR .DEPARTMENT USE ONLY <br /> 14 <br /> APPLICATION ACCEPTED BY _ --------------------. DATE ----•------------------- <br /> BUILDINGPERMIT ISSUED ----- ---------------------------------------------------- ------------------------ ----=--------------DATE ------------------------------------------- <br /> k ADDITIONAL COMMENTS ------- --------------------------------------------------------- <br /> -- ----------------- <br /> ----------- -- ------------- <br /> ------------------------------------------------ ------------------------------------------------------------------------------------ <br /> ----- ----------------------- <br /> ( Final Inspection by7 Date _9- '7d - ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 ' 1268 Rev. 5M <br />