Laserfiche WebLink
FOR OFFICE USE: <br /> a <br /> APPLICATION FOR-SANITATION PERMIT <br /> { FPermit No. <br /> .F .. .,: _ (Complete P ete in.Triplicate) r ..... <br /> Y.4 <br /> ThIs_Permlt Expires t Year From Dote issued,, , Date Issued ..-L..'12 <br /> Application is herebymade to the-San.Jooquin L co al_Health District for ��� <br /> q permit to wnstruct and Instal! the work herein <br /> described. This application is made in cdrripfionce with County,Ordinance No. 549 and existing Rules-and­Regulations-- <br /> f <br /> I=G•T r <br /> .........CENSUS TRA& <br /> JOB ADQRES5/LOCATION .-_--°___-.:....-_-• a <br /> Owner's Name ' <br /> . .... Phone <br /> Address <br /> �4�!p.�-------------•-- _..__..... city.....�7_`�:w_..._...:. ,�:*�: <br /> - � r <br /> Contractor's Name ..--...License 91E ....... Phone <br /> P ..............---. <br /> Commercial Installation will serve: Residence D4 Apartment House 0 Commercial[3Trailer Court E) <br /> -Motel-0,Otht3r.. ....`.......":'............. <br /> Number of livingunits:--/ Number of bedrooms _. --_.::.Garbage Grinder _.....d... Lot Size .....�a � ­OO-:.•_� <br /> �✓ <br /> I • <br /> Water Supply: Public System and name .............. -•...: ...:.......- .....:....._.__....._ - -.......................................... <br /> _ Private�.. <br /> Character of soil#o a depth`of 3 feet' -"S+:Trid'0 Silt o Clay ❑ Peat❑ Sandy Loam jQ Clay loam ❑ <br /> i Hardpan r Adobe 0 Fill Material ............ If yes,type ....... .. ............ <br /> (Plot pian, showing size of lot, location of system in 'relation tor wells, buildings, etc: must be placed on reverse side.1. <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 204 feet,) <br /> PACKAGE TREATMENT: ( ] SEPTIC TANK I ] Size...............!....._...---•._.... .--..�._.... Liquid,`Depth <br /> + .................... <br /> :.-+ Capacity .-__ TypIN <br /> .___.__ Material.. .. 'No. Compartments <br /> • f <br /> Distance to nearest. Wel .............................M:..Foundatlo ...................... Prop. Line _ <br /> LEACHING LINE C j "No. of Lines ..................._. ength of each line...... -------- --.-:�- Total Length ............................ <br /> 'D' Box ......_ .... Type filteaterial ....................Depth Filt r Materia! ....... <br /> ..................................... <br /> f_ <br /> $C Distance to nearest: Wel! ......:.:........ Foundation "...._.. ........ .... Property Line ........................ <br /> SEEPAGE PIT [ ) Depth .................... d)iam ._.---------••-- Number .............. ..-.--------- Rock Filled Yes No ❑ hi <br /> ... 4�Woter Table Depth ......... ................................ .Rock-Size $='� .................. <br /> Distance to nearest- Well � .' .......................Foundatio � � .. Prop. Line .....:........ p <br /> REPAIR/ADDITION(Prey. Sanitation Permit# .....__.. ------------------•-- <br /> --...__ Date .-------- ..................... <br /> Septic Tank {Specif)-;Requirements) `+ _ <br /> 'r- GBAt1 _ tv <br /> Disposal field (Specify Requirements) --•- -• -7V.._: � �c ....................... <br /> N a l 3— <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 Ingaccordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:Dlstdct. Home owner or liven- <br /> sed agents signature certifies the following: <br /> "I certify that in the a rmance the work for which this permit Is issued, 1 shall. not employ any person in such manner <br /> as to become su. rkni Com nsation laws of California." <br /> Signed:: _ s - ----------• ....... <br /> By ...---- ---_----------- -------------------_--------- `• .•'-..:.:. Title <br /> y <br /> ,.o..11f.other. than .ownerl_,-..-_ Y_ •� .,,....,.��._. ..,��...�:.. ".,.,.v-�:;.�.... ._. <br /> FOR DEPARTMENT- USE.ONLY <br /> APPLICATION ACCEPTED BY ®- .. ............. ------: DATE _...; �`Z = = = = <br /> BUILDING PERMIT ISSUED :..................'--._-.._ ...____..-•-••--- <br /> DATE --- --------••------ <br /> ADDITIONAL COMMENTS ------------- --•---.._. ....:...----•----••----....... :...-- <br /> • <br /> -------------------- <br /> ------------------------------------------ t <br /> ... •-••--------. __....... -... . <br /> Final inspection by; --------- _Date .�.......... .............. <br /> EH 13 2b 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> .. <br />