Laserfiche WebLink
V I. I D90 <br /> FOR OFFICE USE, <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ..............................•-........ <br /> 7 (Complete in Triplicate) <br /> ........................ 7K <br /> This Permit Expires I Year From Date Issued <br /> ......I....... .........._ Date issued ....... <br /> ................................ ..........._.-.1 <br /> Application is hereby made to the San Joaquin Locol'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/LPVA�kT16N _.q;��..CENSUS TRACT ..........-...... <br /> .............. ...............Phone .............. ............ <br /> OwnersName ......... . ...... ............ ..... .. ...... ................. ....... <br /> 7_ Ci ........ <br /> Address ............ ------ ------ ......... ty ... ....................... <br /> Contractor's Name ......... .. .. ..... .............. license # Ar Phone ............... .......p...... <br /> .Installation will serve. Residence partment House 0 Commercial 13Trailer Court 0 <br /> Motel C]Other ----------- <br /> Number of living units:.__..._J.__. Number of bedrooms ...:�_Gorbage Grinder ---------... Lot Size ............. .. ....................... <br /> Water Supply: Public System and name ---------•-•--.....---•--•---._... .. --•- ------------ .......................................................Private <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay 0 -' Peqt Sandy Loam QT'-'Clay Loam 0 <br /> Hardpan ❑ Adobe C] 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................•------.-----........_...._.._... Liquid. Depth .......................... . <br /> Capacity .........I.......... Type .................... Materal...................... No. Compartments ....................... <br /> Distance to nearest- Well ...Foundation ---- ------_-------- Prop. Line ................... <br /> LEACHING LINE No. of Lines ........................ Length of each line....._____.....____....__.-: Total Length ............................ <br /> 'D' Box ............ Type Filter Material ----------- ....Depth Filter Material ................ <br /> Distance to nearest- Well ......................... Foundation .... .. <br /> .. ................ Property Line ................ ...... <br /> SEEPAGE PIT Depth .................... Diameter .------- ----- Number ... ............ ........... Rock Filled Yes 0 No <br /> d <br /> WaterTable Depth ................................................Rock Size .............................. <br /> Distance to nearest. Well --_--_---7--7 ......................Foundation ......................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...... .............. Date .................................. <br /> c-, Q............ . .... ...................I................. ......................... <br /> Septic Tank (Specify Requirements) 1P___L_4171---- ------------------------- <br /> Disposal field (Specify Requirements) �.. ... ........1. -...... ................. <br /> .......... <br /> .............. .................... ............... .................. ............................................................. ........................ ----------- <br /> .................. ......................................I.......­................... .......................................................................... .................... ................... <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 Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son 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 ornploy any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ................................ ........ ....... ... ........ ....... Owner <br /> IV ...... .................. <br /> By Title.... ........................ --------- <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY ­7 1 7'. <br /> ........ DATE ..... <br /> APPLICATION ACCEPTED BY ................1_4 .........................I....................._.............. <br /> BUILDINGPERMIT ISSUED .........—................................................. .........I................... ..........._DATE ............................... ............ <br /> ADDITIONALCOMMENTS ............... ................................................................ ................................... ............. ........................... <br /> .......... ...... ............................. <br /> ............................................................................. ..............................7...................... ........... <br /> .......... ............I................. .................. ....... <br /> ......................... .................... ........................................................... <br /> .................. ....... ..................... ..................... ..........I...............I...... .................I.......... ........I........ 4................... <br /> ................ ........... <br /> Final Inspection .......................................................... ............................Date .... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F_ H.13 241-'68 Rev. 5M 7/72 3 A <br />