Laserfiche WebLink
` X "'"TAX b`' I APPLICATION FOR SANITATION PERMIT <br /> ................•-............. ......................... Permit No. 75.............. 1 <br /> ;Complete in Triplicate) ' <br /> ....................................................... Date Issued <br /> ............ .......I...... .........I.......... This Permit Expires Il Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constnict and Install the work herein <br /> described. This application Is made in compliance with County Ordinance No. 549 and bxisting Rules and Regulationst <br /> JOB ADDRESSAOCATION . -- ... <br /> . .. .... ........... .. . •--..........CENSUS TRACT ......... <br /> WJC .Owner's Name ............1 . . n ....... ...................................Phono7yl ....-..._.... . <br /> V <br /> Address . . ...................... ..............--•--.........--...ciN ............_. <br /> Contractor's Name ............................... .............................. # ....----...---•----_.... Phone .............................. <br /> Installation will serve: Residence XApartment House❑ Commercial❑Trailer Court ❑ <br /> Motel ❑Other l <br /> Number of living units:......I.... Number of bedrooms:....Garbage Grinder ............ Lot Size . _ ..- � ••..•... <br /> Water Supply: Public System and name ........................................................._.................................................. <br /> Privy <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam day Loam ❑ <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 I ] SEPTIC TANK f ] Size................................................ Liquid Depth .......................... <br /> Capacity .................... Type .................... Material...................... No. Compartments ---.................el <br /> Distance to nearest: Well ................................ __Foundation ....................._ Prop. Line <br /> LEACHING LINE [ ] No. of Lines ........................ Length of each line............................ Total Length ..........................A <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ......................................... .� <br /> - , Distance to nearest: Well ........................ Foundation ........................ Property Line ....................... <br /> SEEPAGE PIT [ ) Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No ❑� <br /> WaterTable Depth ................................................Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation .................... Prop. line .................. <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date ................................ .I <br /> Septic Tank (Specify Requirements) ............... . ....... ..�,/ .... .--.._ ... . . .� <br /> Disposal Field (S cify Requirem��ts) ._. •• - " -••• 11 �`� pd! - <br /> J pe ....�^..... -A ' �., •• .11 `—�. ....._—L .._.4. . . ...... . <br /> --_ ... .. .... ..../. � ............ ....._...... ...... <br /> � jr♦ 4 <br /> 1/ 1113raw,e s ng and required addition an reverse side) <br /> I hereby certify that ave 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. Herne owner or Ilcen• <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of the work for which this permit is Issued, 1 shall not employ any person in such manner <br /> as to become le t to ork�n' mp sqnl s of California." <br /> Signet! X..-...---• • --- -!- � ... ........--•-.--... Owner <br /> By ..... ............. .................................................................. .......................... title ....-............................................ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... .... -. ..-...........t................................................................... DATE .... �. ... .. s .. ...: <br /> BUILDING PERMIT ISSUED ..........................DATEl......... ................................. <br /> ADDITIONALCOMMENTS .... . ........ .... ................... •- ........ .....-....___................................ <br /> ........... .. . . . . <br /> ........................ ................... ...... ......... ........ <br /> ... ... . .... ........... ................................................... <br /> r . .. ............:............................................................ <br /> Data � ..~.. ... <br /> Final Inspection by: .. .- ------ <br /> EH 13 2L 1-68 Rev. 5l SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />