Laserfiche WebLink
FUR OFFICE USE: i <br /> APPLICATION FOR SANITATION PERMIT7s..-6J.T'` <br /> .._ ....................•-----1 ....1.-. <br /> (Complete.In Triplicate) Permit No. ..................... <br /> _1111. ............................................. _ _-. <br /> _..•-- This Permit Expires 1 Year From Date Issued Date Issued A./f/7. . <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and Install the work herein <br /> described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .__... '. _ fib ..._.... ''.`.. I � .. CENSUS TRACT .......................... <br /> Owner's Name .................. � ...............................Phone ....................--- ......_... <br /> Address ..... .......- -----...--- ................. ..---1111-• City ......:.... . ............. . <br /> Contractor's Name -------- C�.............. l*. . .A:Ye License # Phone <br /> Installation will serve: Residence❑Apartment House[] Commercial W,railer Court ❑ <br /> Motel ❑Other...-•------•.............................. <br /> Number of living units:_. _ Number of bedrooms _ -•Garbage Grinder ...w... Lot Size ......................... <br /> Water Supply: Public System and name .................. ... ........___..____.....__....._111_..............1......_._ ............Private <br /> Character of soil to a depth of 3 feet: Sand L3 Silt o Clay ❑ Peat❑ Sandy Loam o Clay Loam„ <br /> Hardpan p Adobe❑ Fill Material ............ If yes,type ............... ............ <br /> s <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> i <br /> PACKAGE TREATMENT j ] SEPTIC TANK I ] Size----------------------------------------- Liquid Depth .......................... <br /> Capacity ............... Type .................... Material ................ No. Compartments ..................... . <br /> Distance to nearest: Well --1111--1....__....:................Foundation ...................... Prop. Line ................. <br /> LEACHING LINE No. of Lines _11.11... r <br /> __.... Length of a ch line..--- ...."� i Total Length .........7.4r <br /> i 'D' Box .._ ► Type Filter Material .._ .Depth .Filter Material ...........:.....���...'.�. <br /> Distance to nearest: Well __ ..r... .... Foundation Property line .......... <br /> I SEEPAGE PIT Depth ._.'° _ #-- Diameter --- Number --._-.----71............. RockFilledYes No ❑� <br /> Water Table Depth `Q.- ...................... <br /> --------•.....•......Rock Size ...........2.,:t ...... G <br /> Distance to nearest: Well ---..._r {. ..............Foundation ----- ..C.?_'.._ Prop. time --- •�-•-�� <br /> REPAIR/ADDITION(Prev, Sanitation Permit# ............................................ Date ------------- ................. f <br /> SepticTank (Specify Requirements) ----_--------------- ........ ....................................................—......I.......... .......1.-......................... <br /> DisposalField (Specify Requirementsl --------------------------------------- --------------------------------------....................__---------------_ .--•----------- <br /> -------------- --------------- -------------------------------- --------- ----­------------------ --••--•--•............................- _1 ...................... ............... <br /> I ----------------• -----•-------------------------- ------------------------------------------------------......................... ................_.-............................................ <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, 1 shall not employ any person in such manner <br /> 6 <br /> as to become subject to Workman's Compensation laws of California." <br /> { Signed -------- cu <br /> -------------- ---. <br /> _ .......-•.... Owner <br /> BY ..........- - ----------• J itle -.._ <br /> (If other than owner) <br /> j FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ............: DATE g 1' --7 <br /> j BUILDING PERMIT ISSUED -_--------------- ....... •-••---- • • •----------------------•.11.--11------- ------- <br /> 1111--- <br /> DATE -----------._-_-------------------------. <br /> ADDITIONALCOMMENTS ----- ---------------- ------------ ...................... ------------------------------------------------- ------------..-.._...__---------------------- <br /> ------ ------------------------------------------------------------------------------ ...... --------------------------- -------- ---------------------------------------------•-•--------••-------•---............... <br /> . <br /> -----------------------------••---- -------- --------- ................. - - -------------.....--- ----- •-----------------------_ -;;7�`-----. <br /> Final Y� 1111-- - -- _ .- <br /> Inspection b 1111 ... .......... .......................................................Date 11 ........................................ <br /> P <br /> EH 13 2h 1-68 Rev. 5M SAN JOAQUILOCAL HEALTH DISTRICT 8711 3M <br />