Laserfiche WebLink
. _ I <br /> FOR OFFICE USE; FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 7 —,2-,nz <br /> (Complete in Triplicate) Permit No.___ ...._.. . <br /> .................. This Permit Expires 1 Year From Date Issued Date Issued_._`_..._.____. <br /> Application is hereby.made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 49 and existing Rules and Regulations: <br /> JOB ADDRESS/LO�C I N.._]>!--o_-_.__d..__. ............ .... .---- --.......... <br /> ................. <br /> .....................CENSUS TRACT <br /> owner's Name._r'-` h <br /> ...................... ............C. . .... <br /> Address.. '_.. ..... . Phone ity..... Zip--e6774 <br /> Contractor's Name..L r <br /> / .................................. Icense #.. Phone <br /> Installation:wili• serve: ~` sidence W,;�T Aportment-Ho#e o Commercial ❑ Trailer Court ❑ r <br /> . .: -s�"Motel:❑'-�t5ther--=----�-�=`�_ _-- .. . <br /> Number,of hying utiits:...........,__.Number of.bedroom' s.._____,._Garbage Grinder.,._... v• <br /> Water Supply: Public System and name--------------------------------------------------------------------------- ------------------ <br /> F <br /> •-•--------- ---- = :... ..Private <br /> I - <br /> ......... <br /> I Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay❑ Peat❑ Sandy Loam a Loam <br /> Y ❑ <br /> 1 Hardpan❑ Adobe❑ - Fill Material___._'.- -__if yes,type_______________________�.__._.. <br /> + , <br /> (Plot plan, showing size of Iat,.locati�of.system:in�elation'to wells, 6uildings,'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 />{ PACKAGE TREATMENT [.) SEPTIC TANK ' Size.._ _:..:__.. . Liquid Depth------------------------ <br /> e <br /> . :. Cdpacit pe.--d` moo!-Matertal--------•------ ---------No. Compartments------�.------------­----- <br /> Distance <br /> ----------. ---- + <br /> Distcenceto nearest: WelL._•_/ ---•--:--- -•_---Ft+undation._� --------------Prop. Line---.----------------_--�.. <br /> LEACHING LINE [�I No�f:Trines----�"'3--�.:�'�.Length of each line------------------------.......Total Length................... <br /> --' <br /> Box <br /> -------- Filter Ak0erIal:------ ------------Depth Filter Material--:------.----.---------------------------_------------- <br /> "' Dist%ncetdnearest: ......Foundation...:_�,.:'.c`: Property•_.___ Line_______________________ <br /> SEEPAGE PIT fj ] Depth-_•....---------Diameter?=77,-----------Nurnbei:`......... <br /> ---- Rock Filled Yes❑ No <br /> iWater Table Depth..-_.......-.._.---------7-------------- --- ...,_.___.Rock•-Size..-,..... + <br /> { Di4tahce to nearest: Well........,.:........:.:..... ......Foundation-------- Prop• Line..................... 1 <br /> REPAIR/ADDITION {prey.Sanitation Permit#............ .......................... .. .....Date_... ] <br /> ---- <br /> Septic Tank [Specify Requirements)....__ � <br /> :x ...... -- = ... <br /> Disposal Field (Specify Requirements)...................... ._ _..._______._ <br /> I . <br /> I f <br /> --------.. -- :... <br /> _______________________.-.-_______-:....._._._ _ ------------------------------------------------ -------------------------- <br /> (DraW'existing and required addition on reverse side) <br /> ! hereby certify that 1 have prepared this-application and that the work will be done In accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licensed agents <br /> signature certifies the Following: r : <br /> ..I ceMFy that in the performance of.fhe'work for which this permit is issued, 1 shall no 'emplay any person in such manner as <br /> to become ub)ect to Work s. Compensation laws of California." <br /> Signed ` - -- - - <br /> LT <br /> nor <br /> BY----- --------------------------•-••------... -------------- Title............. <br /> [If other than owner) <br /> i FO EPAR ENT USE ONLY ' <br /> APPLICATION-ACCEPTED BY __ ..__ __.____ ��-_ <br /> p .............................. ...DATE.. _.._.._........... <br /> DIVISION OF LAND NUMBER.. - ...__-- -- -----:-------------- ----: :.DATE.....-- ----------------------- <br /> ADDITIONAL COMMENTS................::-- ....... <br /> ._.... •-------•-----.--.._....---•••..........-•-------------=------ = --- <br /> 1 : •............. ---------.........................................................••-------------------•-t------------------------------------------------------------------------------------- <br /> ............- <br /> .............. <br /> Final Inspection by:_ -._..-- - - - --- - :. ..._ ...- - -- �-------------Date. <br /> i KH 13 24 SAN JOA N LOCAL HEALTH DISTRICT ras 2W7 REV.7/76 3M <br />