Laserfiche WebLink
FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT......................................................:� Permit No S � <br /> (Complete in Triplicate) <br /> ....................................... Date lssueds_.:/-f , <br />.,,_.•.... .........................•.....--....-.- ...... This Permit Expires 1 Year Front Date Issued I <br /> Applicotion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is'made in compliance with County Ordinance No. 544 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATI N - .a2... :............G- -•.. CENSUS TRACT ..... <br /> Owner's Name ....... .-. . . . .. --.. ...... ...-- .... Phone .. <br /> Address ..-... ... .- _:I�._...:. --- ..-..,Z.'.................... City '.--.. <br /> Contractor's Name t-, �...- ��License # oZ�v. P�l y1'- Phone & ''.'.- <br /> Installation will serve: I ResidenceApartmemtse-❑ Commercial []Trader Court 0 <br /> I Motel ❑Other ..... •...... <br /> Number of living units:.. .... ,`:... Number of bedrooms -..-L..-Garbage Grinder ._`F-�'Lot Size - -X f-�• • <br /> Water Supply: Public System land name ---...ij-- - -_. ------------:....... ......................Private <br /> Character cI 'soil to a depth ofllllll 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 <br /> Hardpan ❑ Adobe Fill Materia! ............ If yes,type ...........................• <br /> f <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 perrpitted if public sewer is available within 200 feet,J <br /> l ] I' I ] 'Z Material •-- .--•--•--• Liquid Depth ..................... <br /> PACKAGE TREATMENT I SEPTIC TANK� ��['��'��'�c�---- ------------ i <br /> N Capacity .. ..... ...... Type ---•................ ate .............. No. Compartments -------- ............. <br /> t C Distance to nearest: Well . ....__... ....... ..........Foundation ......... Prop. Line ..-,. <br /> LEACHING )INE No. -. . . . .of Eines _.. Length of each line...V..a.......- ..--- Tota! Length <br /> 1 <br /> 'D Box ..-/... Type Filter Material ...Depth Filter Material .. j -- -----------------------••--v' <br /> .- <br /> . <br /> Distance to nearest: Well 1----------- Foundation �- ......... Property Line -. /I.......... <br /> SEEPAGE PIT Depth o71-5"` -.._- Diameter -.....--- Number I-.- --- Rock Filled Yes ( No ❑S <br /> -. <br /> Water Table Depth .......-�.�-�------------------------------Rock Size �......---•--•---•---..-. <br /> .Foundation . ---- -.` <br /> ....- <br /> piss ance to nearest; Well .��G�--- --------------------• .��-.- --- Prop. Line -........------_--• <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...'--...................•---.... --- Date --------------------.._...-------) <br /> Septic Tank (Specify Regvirements) --- .. .......... ------------------------------ <br /> n D <br /> Disposal Field {specify R'equir meets} - - -- - . ---- <br /> �y� <br /> .r" ............. ...-----....--- ....--.. <br /> f... -- - •. ... -- p <br /> [Draw existing and required addition on reverse side) <br /> I hereby certify that I havel' repared 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 /> 'f 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 ...... .. .......... ............ <br /> . Owner <br /> BY i �1-�er <br /> �, ..... ........ Title <br /> 4(ifother th <br /> DEPA TME14T IIII&E ONLY <br /> APPLICATION ACCEPTED BY i1. ............::.. DATEBUILDING PERMIT . ..-' .... <br /> ' ----------•--........... <br /> ADDITIONAL COMMENTS ..TS --- .--•-- --.-.--.------------------- -• -------- - ---•------- ...DATE . - - -- <br /> ------ <br /> �M ----- --------- -- ..................... ..--... --.. ---•--.................- ...-.. <br /> f ------- -------------------- ------ ------ -..-. - ... <br /> -- <br /> -------- --------------------- <br /> t Final Inspection b . ............:.........•-..-.-_.-_. <br /> . Date .� --- ---- .� <br /> I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> a <br /> F w 13 24 t.'Aft Rav SM 7 2 .K <br />