Laserfiche WebLink
FOR OFFICE USE: <br /> \\ APPLICATION FOR SANITATION PERMIT 7S 767 <br /> Permit No. <br /> lComploo In TrlpNeatei ....... <br /> .N. . ... . ....... .. .. ....... This Permit Expires 1 Yew From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work berets <br /> described. This application is made in coompliance with County Ordinannnce No. 649 and existing Rules and Regulotksns: <br /> 108 ADDRESS/LOCATION �1....,. ....... �� CENSUS TRACT[ <br /> Owner's Name .... .. .....�.,...,�� / .. ...... .. .,. ... :.:.. .....Phone ................ ... ................. <br /> Address ............................ 'i ..V................ . . .......City ........................................................ <br /> Contractor's Name .. .iu..:.. .. .........................License Phone <br /> installation will serve: Residence� rMuent Haue0 Commercial OTraller Court E3 <br /> Mete!❑Other... .............:..... ........... <br /> Number of living units.�. ...... Number of bedrooms bc. a Grinder. ..... Lot Slee .. � ... <br /> Wats Supply= Public System and name ......... .. ..»:.......................... ................ .......PrivsrM <br /> Character of sail to a depth of 3 feet: Sand E3 • Silt Q+~ CI Peat Q Sandy Loam C3 goy Lem[� <br /> Hardpan 0 Adobe PIN Material............If yes,type............... ............ <br /> !Plot plan, showing size of lot, location of system Ly4latlon to wells, buildings, etc, must be plwaced an reverse elds►.I <br /> NEW INSTALLATIOMh (No septic tank or seepage pit pwmNted if public sewer is available within 200 feet,l <br /> PACKAGE TREATMENT ) SEPTIC TANK , „ . .:.............. Liquid Wpth .�....r <br /> Capadly . Type . ..�. Maln�ial.. ...... No. -.............. <br /> Distance to nearest: Well .. .... ...................... <br /> V1_ <br /> Distance ,��.. ....Is". Lim a�►t� <br /> LEACHING LINE No. of Lines ...... . ............ Length of each tMe...�/l�!d . .......... Ta1o!'Lenpth �..�...... <br /> 'D' Box,(✓'�..0.. Type Filter materia! ..,��'��Drpdt Filter Mestsrhd /e................................. <br /> Distance to nearest; Well ........... Foundation f. ............ Properly Une ............. <br /> SEEPAGE PIT Da <br /> ( pt#t .....: �....... r' ,.Y.�:..... Number ............. Rod; PAW Yeti <br /> Water Tatble Depth ......... .... ...................Rocit <br /> Distance to neamt: Wolf ..... .. . ... .........Foundation .........Prep. Line .. .. ...... <br /> RiPAtR/ADDITIFlPI!Prov. Sanitation PemRt#t+IP DaM ...I 'I <br /> Septic Tank (Specify Requirements) ............................... .............. ........................:......................... .. ..,...... ..........�, <br /> Disposal Field (Specify Requirements) ............. .... ... ........ . ... ......... .. ......... ..................... .......... <br /> .............................. <br /> .....------•..............(Draw existing and required addition on reverse sidol . ................................... .. ........ <br /> 1 hereby certify that 1 have prepared this application and that the work w!N be done In acuWanse whk Sea Jas qub <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Lova! Health,District. Now ew" r or, Naw. <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this p+rmlt is issued, 1 sho not employe any petaen is welt t omw <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .... -- ............... //..�.........cc..,,.....:.............. Owner <br /> By ..... .. ..GS�..� .. .,......: ......... <br /> (If other than owner) <br /> FOR DEPARTMENT S ONLY <br /> APPLICATION ACCEPTED BY ...... .......................................'.....-. DATE . .fQ-1:?5.................. <br /> :...; <br /> BUILDING PERMIT ISSUED .................................... <br /> ............. . DATE ....... ............................... <br /> ADDITIONALCOMMENTS .............................................,..................................................... ........,............ <br /> ....................................................................................................................................................... .................................................. <br /> ...................................-.........-....................................................................................................................... <br /> ..............................................................................................................:............... . . <br /> FinalInspection by: ................................ ................................... ................ ....... . .................Date . f©.. :.f 7:4�.......I... ... <br /> EH 13 24 1-613 Rev. 5M SAN JOAQUIN LOCAL HEAL !STRICT 8/7b 3M <br />