Laserfiche WebLink
FOIE OFFICE USE: APPLICATION FOR SANITATION PERMIT / <br /> ---- --- ----------- -- -------- ------------------------ f f� <br /> (Complete in-Triplicate) Permit No. T/ <br /> ---- ----=-- --------------- ------------- ------------ <br /> =; <br /> --------------------------------------------------------- This Permit Expires 9 Year From Dj*e Issued <br /> 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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> r <br /> JOB ADDRESS/LOCATION --- C1Q------- ,------- ---------------CENSUS TRACT -------------------------- <br /> Owner's Name -----�-_------ 2 1n1' L ----------------------------------- --------------------------------------Phone <br /> -I �N <br /> Address ------------------------(.11--Q1- --- V ----------- ------- City --------------------------------------•••-•-• <br /> Contractor's Name ---------- Cray ------------------------ - __.License # -----�------- Phone ------------------------------ <br /> Installation will serve:I"%,,Z , 2esidenceXApartment House-E] Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:._!----- Number of bedrooms ________---Garbage Grinder ------------ Lot Size _______________________________________ <br /> Water Supply: Public System and name ------------------------------------------------------------ ------------------------------------------------Private Eg] <br /> Character of soil to a depth of 3 feet: Sand❑_ Silt❑ Clay'❑ Peat❑ Sandy Loam ❑ Clay Loam 0 <br /> Hardpan ❑ Adobe N ,iill 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.] E <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f,4/ Size_______________________________________________ Liquid Depth ------------­------------ Q <br /> Capacity Material-�_CJ No. Compartments ___ --------------- <br /> Distance to nearest: Well ___________________________________Foundation ---------------------- Prop. Line --_------------------- (� <br /> LEACHING LINE No. of Lines ------- ________ Length of each line----------4-C-------- Total Length ______-(20-11--- <br /> r (� <br /> 'D' Box _Z___ Type Filter Material Depth Fitter Material _____iQ___rl_----_--------------------- <br /> Distance to nearest: Well _______________________ Foundation ------------------------ Property Line ___-___________-__._.__- <br /> SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation _________________ Prop. Line __________..__...._... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) <br /> SepticTank (Specify Requirements) --------- ----------------------------------------------------------------------------------------------------•----------------------------- <br /> Disposal Field (Specify Requirements) ------------ --------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have 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. 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 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed --- -- -------------------------------------------- Owner <br /> 2 <br /> BY ---------- <br /> -------------------------------------------- Title -------- --------------------------------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- -_-- DATE -.-----16Z Z__�------------------ <br /> BUILDING PERMIT ISSUED ---------------------- ---------- DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS --------------------------------------------------------------------------- ---------------------------------------------------------------------------------- <br /> -----------------------------------I---------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- <br /> -------------------------------- - <br /> Final Inspection b __ Date ___. ---�1 <br /> --•------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M C <br />