Laserfiche WebLink
FOR OFFICE USE: <br /> ••APPLICATION FOR SANITATION PEWMIT <br /> Permit No. <br /> - -- - -- -------- - <br /> (Complete in Triplicate) <br /> -------------------------------------------------------- <br /> This Permit Expires 1 Year From Date Issued 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. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION . 4�6G4--------z<q Eo -S----R-P ---------------------------------CENSUS TRACT ----------------_-------- <br /> Owner's Name Yi4./.+1._��b --------------------------------------_ ------------------Phone ------------------------------------ <br /> Address -----------------------------------------------------------------------------------------------------•-- City --------------------- <br /> Contractor's Name ---�'}� -_-__1�� -----�---5 <br /> License # Phone CJS <br /> Installation will serve: Residence 2rCpartment House❑ Commercial :❑Trailer Court ,❑ <br /> Motel ❑Other ------------ ------------------------------- <br /> Number of living units:.-__ Number f bedrooms _Garbage Grinder -----.______ of Size ____� � ---_-------_------- <br /> _______ <br /> Water Supply: Public System and name . .1_ Private [�---. <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Q Clay Loam j] <br /> Hardpan ❑ Adobe 2-1*'FiII 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.) Oc <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) C <br /> r C <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ --------------- Liquid Depth --__ _--__-_------ <br /> Capacity ----.- Type Material______________________ No. Compartments _. ............ <br /> Distance to nearest: Well ____________________________________Foundation _._rc�------------ Prop. Line ___-_____l____----___ <br /> LEACHING LINE No. of Lines f <br /> [ ] �__-____..._-_--_ Length of each line-__._�� ____--_-__-.--- Total Length -_,-2_.76............... <br /> 'D' Box ...f....... Type Filter Material ____________________Depth Filter Material _-_-_-______--.__--_-____-_-_________-__---- <br /> Distance to nearest: Well ________________________ Foundation ------------------------ Property Line -.__-.-__-.____--_-_-___ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number --------------------------- Rock Filled Yes ❑ No Q <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 /> DisposalField (Specify Requirements) --------------------------------------------------------------- ---------- --------- ---------------------------------- -------- <br /> -------------- ------------------------------ ------------------------------- ----------------------------------------- ------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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 /> B �/ ---- --- Title _. - <br /> Y - ---- ---------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYA <br /> " ------------------------------------------------------------- <br /> DATE ----Ib + _ - <br /> BUILDING PERMIT ISSUED --- --- ------------ --- --------DATE -------------------_- .................... <br /> ADDITIONALCOMMENTS -- ------------------------------------------------------------•------ ----------------------------------------------------------------------•---------------- <br /> ----------------------------------------_------------------------- -------------- -----------------------------------------------------------------------•----------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - ------� <br /> Final Inspection b ° � -------Date 7 . . 7 ---.--..--..-..--.-..--..--..-.-.-. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT �> <br /> c u n i eco n-.. rAd <br />