Laserfiche WebLink
FOR OFFICE USE: <br /> _ APPhICATION FOR SANITATION PERMIT /�; -- <br /> A � Permit No.6q,:� <br /> l (Complete in Triplicate} <br />------ ----------------------- -----------I """"" Date Issued <br /> - ---------------------------------------------- This Permit Expires 'I Year From Date issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct End install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing les and Regulations. <br /> 41 <br /> JOB ADDRESS/LOCATION/—,;P X <br /> _ - . CENSUS�TRACT -------------- ---•------- <br /> Owners Name ----/ liar r{; ----------------- <br /> ---------------------------------------- P e. <br /> AddressC.��7" ---------- = City ` i��i <br /> ---- <br /> Contractor's Name %. __ �f/-�' - License#�L�' - -- -- Phone4s' -�1�.� - <br /> installation will serve Residence Apartmed. nt House-E] Commercial❑Trade Court [] <br /> Motel ❑ Other, -------------------------- <br /> 001% i r <br /> Number of living units:___ - ---" Number of bedrooms -, ------Garbage Grinder Lot Size - - j—Z ------ <br /> Supply: <br /> ------------------ <br /> PP Y Y � ! �< -/ Pe Viand Loam Private ❑ <br /> Water Su I P blit S stem and name " '__ _-€ -�_-:_ _ ��---- 1&241-------- - <br /> Character of soil, 0 a depth of 3 feet. Sand ❑ Silt❑Clay ❑ ❑ � y ❑ Clay- ❑ �#� <br /> Hardpan ❑ Adobe-$ Fill Material --------"_- If yes,type ------------ -_.---"_------ <br /> (Plot plan, sho wing size oir lot, location of sysfiem in relation #o welts, buildings etc. must be placed on reverse side.1 <br /> NEW INSTAI,I.ATION: (No septic tank or seepage pit permitted if public sewers available within-200 feet) <br /> 1-40 <br /> -PACKAGE'TREATMENT f ] SEPTIC TANK;[ ] Size-------------•------------------ --- Liquid depth ----------------- <br /> Capacity -------- ----------- Type -------------------- Material---------- ---------- No. Compartments ------•---------- <br /> Distance to nearest: Well ------------------------------------Found tion ---------------------- Prop. Line ---------------------- l <br /> LEACHING LINE [ ] No of Lines ------------------------ Length of each line-----------I--------.------ Total Length -----------.--------------- <br /> 'D''Box ------.----- Type Filter Material --------------------Depth ;Filter Material --------------------•-----_------••.•--------�% <br /> 41 <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line. -----_------------------ w. <br /> M <br /> SEEPAGE PIT [ ]hDepth ----------- ---- Number --- .-- --. Rock Filled Yes No ,0 <br /> -- - - ------------ Diameter - ----------- - 1 � <br /> �� Water Table Depth --------------------------------------•----------Rock Si ze ------------ry��=---• �- <br /> Distance to,nearest: Well ----------------------------------------Foundattion -------------------- Prop. Line .._______-__- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ....___. ----------------------------------- Dat <br /> e -----1------------.•-----------•--1 . <br /> Septic Tank (Specify Requirements) -"----------------- -------------------------------------------- ------- ----------------------------------------------- --------- <br /> --------- <br /> ,. ' <br /> Disposal Field (Specify �equirements] ---_ A . -- ---------- -' - ' _ ' <br /> ---i- t <br /> -------------------------------------------I ----------------------------------—----------- ------------------------------------ ------------------------- -- ----------------------------------- <br /> (Draw existingand required addition on reverse side) <br /> I hereby certify that 1 havi prepared this application and that the work will ge done in accordance with San•Joaquin <br /> County Ordinances, State L''aws, 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 sh11 not employ any person. in such manner <br /> as to become subject to Workman s C fi.law�'s"of-C-6106"in <br /> Signed --------------- -- --- --------- -------------------------------- Owner <br /> ------- ---------------------- - <br /> Title - ---------------------- <br /> k <br /> (I er than owner) <br /> FOR DEPAitTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- -----4" �-------�p - -- --------------------------------- <br /> --------------------- DATE = -r5--------------- <br /> BUILDINGPERMIT ISSUED ------------------------------------- ------------------ --------------------- ---------=--------------DATE -- <br /> ADDITIONALCOMMENTS ------------------------------------ ------------- ---------- -------------------------------------------------------------------- --------------------------- <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------s--�--------------------------------------------._.- <br /> ----------------------------------------------------------------------------------------------------- ------------ --------------------------------------------------------------------------------------- <br /> ----- ---- <br /> -------------------------------------------------- - - - - - - - <br /> -�`_--' <br /> Final Inspection by. --------- �` l ---- Date i <br /> SAN -JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. 5M. - <br />