Laserfiche WebLink
- FOR�OFFICE USE: � <br /> APPLICATION FOR SANITATION PERMIT <br /> ... -= <br /> ................................ Permit No. <br /> (Compute in Triplicate) <br /> .............................................. <br /> bate Issued <br /> ............ •....t 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 and install the work herein <br /> described. This application made egn�pli wi Co nty%rdi nce No. 49 and existing Rules and Regulations: <br /> C� ...............CENSUS TRACT ...... <br /> JOB ADDRESS/LOCATION ....:......... ....__...._,.... <br /> �� Tarr <br /> Owner's Name .._......�_�.�i-----------------•--.......-•-•---�..........----...............-------......--=-••---------.........Phan ----- ......,............ ---...... <br /> f/�M e ••--•--. City .i ... .................... <br /> Phone <br /> Address � � T d- 5 0..........--•.............. <br /> ............................ <br /> Address <br /> Contractor's Name .._...a.._.._1►'._.. .9.1y-I/" /� ._..License # ��6'.�88 ... Phone !`3--.` �. .... ; <br /> installation will serve: Residence ®Apartment House[] Commercial ❑Trailer Court C <br /> Motel ❑Other ................._-------------..-.-..-.__ <br /> Number of living units:...1-___.- Number of bedrooms .�--__---Garbage Grinder ....._._.... Lot Size _.. '--- <br /> Nu g F <br /> Water Supply: Public System and name __------_------------- ........---------------•---•---•-...................................................Private ® Q <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam . (Clay Loom ❑ .' <br /> Hardpan ❑ Adobe Q 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 /> i r y <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ] Size..... ......•--.•.------ Liquid Depth ........Y..--•--........ <br /> Capacity I ....... Type `------ No. Compartments ` •..........:.... <br /> Distance to nearest: Well .........��- •.................Foundation .._ ...... Prop. Line ......... <br /> LEACHING LINE [ ] No. of Lines -----:3.............. Length of each line._....?4 Total Length - - Q._......---:--=• <br /> �Q„ <br /> 'D' Box .._ .1------ Type Filter Material ... 44 .i ----Depth Filter Material ..............................:............. , <br /> Distance to nearest: Well .---- 60.1.... Foundation .... -.5--�..-----.__ Property Line <br /> 1 { _..... Rock Filled - Yes „ •No <br /> SEEPAGE PIT [ ) Depth .................... Diameter ................ Number ----...---.--...._..._ d <br /> Water Table Depth .... ............. ..............4..............Rock Size ----_-•-•-_---•------------ <br /> Distance to nearest: Well ........-------------...................Foundation __........ --------- Prop, Line _....:---.---•---.--.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit r# ............................................ Date .__........_------._-_-------_--) <br /> SepticTank (Specify Requirements) ............................ ... ......................................................................_........................ <br /> Disposal Field (Specify Requirements) ----•--•---••- ------------------------------------------------------_--_----- ------_--.----- -- •-•---... <br /> ..................... ------ -------------•-•- --------------- -------............................................................................................ <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State taws, and Rules and Regulations of the San Joaquin Local Health District, Home owner GO 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 shall not employ any person in such manner <br /> as to become subject to Workman's Campensation laws of California." <br /> '. Ak T/ri vN f 5 o�y ----• ----------. Owner <br /> Signed ............ .........•------.. ._. ._.._._..........---•------•--------•----. <br /> By .._.._.... - Wil_. _ -...................:............ ..... Title ........................................................................ <br /> (1f of wner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . 11 ----------•----•--........._.....----_. DATE ........ ............... <br /> BUILDING PERMIT ISSUED ...... <br /> ..• ------------------•--•---• .............DATE ........................................... <br /> ADDITIONALCOMMENTS ..................................................................................................................................----------............--•••• <br /> ........................................ -••-•----------------- ...................... ................. ................. <br /> -........---•---- -•---•------•••---_.. ............... =- ---------- --•---•---. ------._.._._._....... <br /> ................................. ... . . . <br /> --- ............... <br /> Final Inspection by: _. .. . •• - . __.._..••------•.................. .Date . .. 9-... <br /> �« SAN,,,JOAQUIN LOCAL HEALTH DISTRICT _ <br /> 7/723M <br />