Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FO OFEIC US <br /> .T <br /> APPLICATION-FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. <br />---------- . . wz-?------- <br /> ----------- <br /> This Permit Expires 1 Year From Date Issued Date Issued - -_7�. <br /> Application is hereby made to the San Joaquin Localeafth District for a per it to construct and install the work herein <br /> described. This application is made in compliance ith County Ordinance No. 49 and existing Rules and Regulations: <br /> JOB ADDRESS/L (�^ <br /> � .. -----------CENSUS TRACT ----------------------.-.- <br /> �� <br /> Owner's Name ---- ---- - 1 ----P�!hPhone <br /> Wil--`---. : <br /> .l � �- � <br /> OT <br /> Address - -------------------------------------------------------- <br /> ----- <br /> --- - - <br /> am - ---.License #Contractor's Name #p <br /> ap <br /> " <br /> Installation will serve: ! Residencepartment House❑ Commercial :❑Trailer Court ❑ i <br /> Motel ❑Other ------- ------�T------------ <br /> ���I• �.,, ._._. .. • . . . • . <br /> Number of living units:-_-----i,---- Number of lom �__-___Garb ge Grinder __ Lot Size - _ , � -..___---_ <br /> Water Supply: Public System and name i--- - - -_ ::. _- ---------------------------Private ❑ <br /> Character of soil to a depth of 3 feet:,, Sand'❑ Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ;❑ <br /> Hardpan ❑ Adobe ❑� Fill Matenal ,Iv-- If yes, type _________.________________ <br /> i <br /> 7 <br /> \}. <br /> (Plot plan, showing size •of, lot, location of system in relation to wells, buildings, etc: must be placed on reverse side.) A <br /> NEW INSTALLATION: (No septic tank`6r seepage pit permitted if public sewer is available within 200 feet,) �r <br /> PACKAGE TREATMENT r SEPTIC TANK' ize___ Liquid Depth <br /> Capacity -- - ----"--- Type ____- Material____-_ -�lo: Compartments ----------•-•--.____-- <br /> Distance tonearest: Wel[ --�_--^ `` <br /> -------- -------- Foundation I C` Prop. Line <br /> LEACHING LINE j No.: of Lines .--� --------------Length' of each line_.__- _-(k ___ Total Length ------__---.---- <br /> 'D' .Box - --�= -:,,Type Filter MaterialDepth Filter Material - - <br /> Distance o nearest: Well ---`1'--------------- Foundation ----------------------- Property Line. _- ----------- <br /> e- <br /> ---- <br /> �. <br /> SEEPAGE PIT /� Depth -. I_--_- Dia to --- ��___. Number --._----- - -,,Rock Filled Yes 0 C <br /> / Water Table De th ) -------------Rock Size __ �_ - ~__< - -. _. <br /> Distance td nearest: Well - -~- *---- '.............Foundation ----- ---- --.�-- Pro Line__T ' <br /> Prop. <br /> R5PAIR/ADDITION(Prev. Sanitation Permif ------------------=------------------------- Date --------.---------------------___-) <br /> SepticTank-{Specify Requirements -- --------------I--------------------------------------------------------------------------------"---•-._--------------------------- <br /> Disposal Field {Specify Requirements) -------------- � <br /> ---------------------------------------------------- ---------------------- ------------------------ <br /> -------------------- ------------'---------- ----------------=--------------------------------------------------------------------------------------- , <br /> '(Dr`aw 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 <br /> icensed 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." y_ <br /> Signed --- ------------- --- - • ------- - ---- Owner j <br /> BY ------------ ---------- ----- --- ,: .� Title - ---- -- �.��---'--------------------------------------------- <br /> �' (If other tharPown <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- '. 'S� f� 3 - DATE --- a -----"7) ------ <br /> BUILDING PERMIT ISSUED <br /> -- ---------------------- } _ � <br /> -DA�T--E- � --.----- <br /> - � -- <br /> -!Yt.u - ---•--cADDITIONAL COMMENTS - - ----- 'f- - --- � �. ---- --------------- -- . U -------------- - <br /> ------ <br /> --------- <br /> s <br /> --- - ---------------------------------------------- --- ------ -----------------Date ------ ---------- <br /> ---- - - -Fincl-Ins-p-e-ction-by:- ------------------------------------------- <br /> SAN' JOAQUIN LOCAL HEALTH' DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />