Laserfiche WebLink
FOR: OFPiCE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ----- - ----- <br /> ---------------- <br /> -- - - � ------ <br /> � (Complete in Triplicate <br /> p Date issued <br /> This Permit Expires 1 Year From Date Issued <br /> ----- .. - <br /> Ap0 <br /> plication 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.49 and existing Rules and Regulations: <br /> ...- �V fo + - CENSUS TRACT <br /> --- <br /> JOB ADDRESS/LOCATION .. s/_7!l- - -- 0 . n -- - � / <br /> �y - Phone 'ylo.a9 <br /> Owner's Name .---/T•r��. �?--- -- `--j-c-tQ.-�+�`Q ��---------- -- <br /> City ------ <br /> Address ----- ' <br /> Contractor's Name -License # !t�Y��( - Phone ro3- --Q --------- <br /> Contractor's . ----------------❑ P <br /> Installation will serve: Residence Apartment House-❑ Commercial ❑Trailer Court ] <br /> Motel ❑Other ----------------------------------------- <br /> Number of living units:../_2_ Number of bedrooms .-.-._.__. --Grinder _­---- <br /> --- Lot Size -- <br /> -. <br /> Water Supply: Public System and name ----------------•---------- - -:-------—-----=--------------- --- -----•------ ----•- -- <br /> Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'[] - Silt,❑ Cla ❑ Peat ElSandy Loam ElClay Loam <br /> Hardpan ❑ Adobe% Fill Material _.- If yes,type ------------------------ --- <br /> (Plot plan, showing size of lot, location of- system in relation to wells,,,buitdings, 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 /> [ SEPTIC TANK <br /> Liquid Depth _.------..:.-:-----..----- ; <br /> PACK%GE TREATMENT ] t:3 - Size-----------------�------- ------ q P <br /> .. Capacity .-..--------- ----- Type ---•-------- <br /> Material/-----."------••--- No. Compartments ------------•-•--•--•- <br /> Cl <br /> # Distance to nearest: Well .__-._.--_.._ ._-Foundation ._..--------------•--- Prop. Line _--..- <br /> - ---------- ------- _ <br /> F ��..r..r... ..- - S\.. <br /> LEACHING LINE [ J No. of Lines --------- -------------- Length of each line..,--------- .-------- Total Length .--.._.._-- �1.._ <br /> 'D' Box ------------ Type Filter Material -------------------Depth Filter Material ---------.-------•----------------- --•----- <br /> Distance to nearest: Well --___.._.-.-_ <br /> Foundation _.------------ --- Property Line -------.---------•- i <br /> __ Diameter �' i"- er _._--.--_�------_`____ Rock Filled Yes, No <br /> SEEPAGE PIT �f Depth -----� ----- .��: <br /> Water Table-Depth - - '. <br /> Rock Size [.. <br /> ..��-------------•------.Foundation Prop. Line . <br /> Distance to nearest: Well __.--___ f, <br /> REPAIR DDITIO Prev. Sanitation Permit# ----------- <br /> ............... ---- Date - ) <br /> -- : t-- -------� .�1'�3- - .......- <br /> Septic Tank (Specify RequiremeTr�'-y--.`--�-� ----- -----"�" - <br /> ;Disposal ,Field (Specify Requirements) --------------------------------------- ---- ---------- -- - <br /> --.`v---------------------------------------------------- <br /> - <br /> -•----------•-------._---------- <br /> ,/ "' ----- --------- - .-----------. . ----- . - ---- ---------- <br /> -- ---------------------------- <br /> r <br /> ---------------- -------------- -= ------------------ <br /> ------- ---------- <br /> ' (Draw existing and,required addition on reverse side) <br /> I hereby certify that 1 have prepared this application pnd 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 ceirtify 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 /> ------.---- Title - --- --------- ------ <br /> (If other than <br /> BY --- - <br /> ------ - - - --- <br /> owner) , <br /> FOR DEPARTMENT USE ONLY <br /> ' DATE _-.__k__ ._9 ---------------- --- <br /> APPLICATION ACCEPTED BY7nZ7_ <br /> BUILDING PERMIT •ISSUED ._.. ----------------------------------------- -•---- --- - -------------- <br /> -.DAT -- --------------- ----------- ---------- <br /> ADDITIONAL COMMENTS ----------------------- ----------------- <br /> ---- <br /> -------------- ........-•-------------- --------------------•---------- --- ------ ------------ ----------- -.- - ------------- --- ..... •---- <br /> .........L-------------------0 <br /> --------------- -------------- ----- ----------------------------------------- <br /> - --- ---- -------- ---------- ---------------------- ------ . ------ <br /> --- <br /> -- - <br /> . <br /> -- --- ---- ----- ----- - - O _ ------ <br /> Final Inspection by: Date -...---- <br /> •------------- <br /> IN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />