Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATI I_--FOR SANITATION PERMIT 7 <br /> (Complete in Triplicatel Permit No. --____-_______.-____. <br /> ---------------- This Permit Expires 1 Year From Date Issued Date Issued _1�1e_AV11 <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/LOCATIONV _-_. <br /> ---CENSUS TRACT ------------------------- <br /> - -- - - - - ---- - -- <br /> ffi <br /> Owner's Name _�£_ :— --------- <br /> - J _ Pfione � ,� --_-- <br /> _Address �f� -- .City M �ii4! <br /> , - <br /> Contractor's Name ___ 4 ^- <br /> -- - -uta----/-t &__.License #/Q��//-� Q _ <br /> Installation will serve: Residence ;<Apartmenst House-E] Coommercial�❑Trailer Court k❑ <br /> 'rT' s •T r . <br /> ------------------ <br /> � <br /> Motel.❑ Other.-:! ----�-------!!��-- <br /> l <br /> r..,,,,,Number of living units:_-f`_- Number of bedrooms <br /> 1 <br /> „ t ;�--- GarlAeJe Grinder . _ �C'ot Siie £( �=;1------ - <br /> Water Supply: Public System and name ______ _______________________----------- _ _ ____ ___ _ - <br /> _ - Private <br /> Character of soil to a depth of 3 feet: Sand`' ,. Si,lt' Cla �• <br /> ❑ y ❑ Peat❑ Sandy Loam.® Clay Loam. <br /> +� Hardpan-❑ Adobe . Fill Material ------------ If yes, type _________________________�- <br /> i <br /> (Plot plan, showing size of lot, location ofIsystem ln-relation,ato.,�,eljs,-buildings,_ptc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic to�k or{seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMEN { ] SEPTIC TAANK�[ ] Size-------------------------- -------- Liquid Depth ---------------• -------- QO <br /> Capacity --------------------- Type -------------------- Material------------- ------? No. Compartments it r <br /> Distance to nearest: Well---------------------------------------Foundation -,----------------.--- Prop. Line ------------------­- <br /> LEACHING <br /> -------___-------- -LEACHING LINE [ ] No. of Lines -------- ---_ ---- Length of each line--------------------#-----_- Total Length --------------- <br /> D'. Box .__________ Type Filter Material ____________________Depth Filter Material <br /> b' istance-to­neurest:-Well ------------------------ Foundation__ __ --- -- Property Line ---------------- � <br /> SEEPAGE PIT <br /> [ l Depth -------------------- Diameter ---------------- Number --------------------- <br /> Rock Filled Yes ❑ No I❑ <br /> Water Table Depth ------------------------------------------------Rock Size --- ---------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _______.._•.--..____ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _------------___--- ) <br /> Septic Tank (Specify Requirements) ---------------------------- ------------- --- - -_-- -- <br /> Disposal Field (Specify Requirements) d ---e.--- <br /> P--- �. <br /> --- - - -- -------- <br /> ----- <br /> ---- ---------------------------------------- --------------------- -------------------------------- ---- <br /> ------------------------------------------------- <br /> (Qraw_existin <br /> g_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 w rk for which this permit is issued, I shall not employ any person in such manner a <br /> as to be a ubject to orkman's Co nsation laws of California." <br /> -- - <br /> t11 w <br /> -------- O n <br /> B µms- Title <br /> ---= <br /> - ----- - ------------ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONlY <br /> APPLICATION ACCEPTED BY --------------------------- _-- - <br /> - <br /> - <br /> - <br /> - +�';" <br /> -------------------------- ---------- DATE ------ --- ---- <br /> BUILDING PERMIT ISSUED - ---- ----------- -- --------------DATE _ --ADDITIONAL ----- <br /> COMMENTS <br /> --------------------------------------------------------------------------------------------------------- --------------------- <br /> ---------------- ---------------------------------------- <br /> -- <br /> - ------------------------------------------------------------------------------ ----------------------------------------- <br /> ---- ----------------------------- -- <br /> Final Inspection by: _-- -- -_--�-- ---_---.gate ----�----r-��- -�_ _:-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />