Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PF" 'IIT(Complete in Triplicate) � <br /> ---- ------ --- --- ----- -------- -- -------- "W (Complete No. _.._---.------- ... <br /> ------- - ----------------•---............. ....... <br /> Date Issued!``--?(9: 7 <br /> ....................._.._..............-............ This Permit Expires 1 Year From Date Issued <br /> . . <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. 5:49 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ._...�.:`...rr�.`�S_­1_1 •-.-.. ..�'..�Z/t'1AAl--.---•--..._._ _.._ -_ _... CENSUS TRACT .......................... <br /> Owner's Name ..._. _�1a/�. ....................••...............Phone ... "..- y <br /> Address . . /.1. . _.�:- N�/�'�`` !Y --------- -- - ..................... Ci <br /> Contractor's Name _------------_------License # ...................•---. Phone -----• ------------_---_- <br /> Installation will serve: Residence ®'Apartment House'D Commercial ❑Trailer Court 0 7 7-G6 <br /> Motel ❑Other _._........-7 A.;1— - <br /> _....... <br /> Number of living units:_ ---_----- Number of bedrooms _..._...Garbage Grinder y ._ Lot Size ...1 2..-----. ------- <br /> Water Supply: Public System and name -------- ------------------•-----•---•---- ---•-- ------........................ ......................_.....Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 15Z <br /> Hardpan ❑ Adobe ❑ 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,) i <br /> PACKAGE TREATMENT ( ] SEPTIC TANK Size__ _____________________________________________ Liquid Depth ....... .......... <br /> Capacity .�_;,a:0-__._ Type� MaterialNo. Compartments ...-._. <br /> e <br /> Distance to nearest: Well __.._-�_ �....................Foundation --------- Prop. Line ..._ 34...._...... <br /> LEACHING LINE [ j No. of Lines ._._ ._..._ _ g l <br /> 3 Len th of each line ._ ..`,.�.'.._.. -.-._. Total Length ,�_7v..._....... <br /> 1 /r <br /> D' Box .-..__._. Type Filter Material S�' '?!�!?'��`Depth Filter Material .......1.��................................ <br /> Distance to nearest: Well _... - Foundation ..-;;. ._.,52?......... Property Line ....:G ....._..._.. <br /> Depth Diameter --- ----------- Number ._. .._- <br /> C <br /> SEEPAGE PIT ....__. _- Rock Filled Yes E] No C) � <br /> [ ] ._ _.---.....---- • . <br /> Water Table Depth ...................................... --------Rock Size ............................... <br /> Distance to nearest: Well .__.....................................Foundation _.__..._._. ........ Prop. Line ............... ...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..............................I............. Date ..................................) J <br /> SepticTank (Specify Requirements) ...................................+........................................................-.......................................... <br /> Disposal Field (Specify Requirements) --.......................... j <br /> - -- - ---- ---------------- ............ ----•---•---.. . - <br /> .••-•----- --•-•-•----•-•----------••--•.... ............................... <br /> 1 <br /> _.. _. . - -- -- -d <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 /> By _-- ------ ------------------------•----------- .................... Jitle _ --- - ....- - <br /> (If other than owner) <br /> OR PARTMEN USE ONLY <br /> APPLICATION ACCEPTED BY -..-... --- •---- --- N..`.�a-= --- . • ---- ------ <br /> ------------- . -- •----.. DATE ... - <br /> _ BUILDING PERMIT ISSUED - - -•- ------- -----• -••-----•--------•--------•----------........... --DATE . . .................. <br /> ADDITIONALCOMMENTS ------I....�;; �_... .- -.._... .... . ----- - --- - •-• -•-_....---•-----•-------...•.................•---•--.... .-_...... ........................................... <br /> ... ..----- ------------- --------- ---- ....................-----._.... . ---------------- -- •--•-•.......••... <br /> Final Inspection by: ... . - ----•-------•------•------------------------- ---*---------•----------.....Date ... �_/ t <br /> / -�................ <br /> EH 13 21a 1-613�i JOAGUIN LOCAL HEALTH DISTRICT <br /> 8/1h 3M <br />