Laserfiche WebLink
rirrL1%oA1JV1V rVK SANlTATI0N PERMIT <br /> .:..............................:................... <br /> . <br /> (Complete in Triplicate) Permit No. _�'. l� ... <br /> ........................... .................. <br /> ............................I................... This permit Expires I Year From Date Issued flats Issued <br /> - <br /> Applicatlon 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/LOCATIO ......---_-7f.7... .- <br /> .. . .:g�y...._..... .................................CENSUS TRACT .......................... <br /> Owner's Name ....... .. .. .. ... ........ .........................-.-.........._. ....-_.Phone <br /> Address ... �7-...��. . .... ...... ...... ...................... <br /> .. . ...- _/ . ._. City ........................................................ <br /> Contractor's Name ?— <br /> . .. ti.,LEcense �8�.3sY......_... Phone ...................... <br /> Installation will serve:.�I ^ 'Residence 6 Apartment House.0 Commercial eTraller Court ❑ <br /> Motel ❑Ofher .................................. <br /> Number of living units:..- Number of bedrooms _•...Garbage Grinder_..............Lot.Size ......._....._.__ .......................... <br /> Water Supply: Public System and name ----------- ...........•.....................................................Private <br /> Character of soil to a depth of 3 feet: Sand t] Slit❑, Clay a Peat❑ Sandy Loam ( Clay Loam ❑ <br /> 0 Fill Material ..._......__ If yes,type ............... ............ <br /> Hardpan [j Adobe <br /> �� ■ I -__ 11�Mi 1 <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,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size.................................... ..........' Liquid Depth -------_--__-----__.-..__ <br /> Capacity .................... Type .................... Material..........-........... No. Compartments ...................--_9 <br /> Distance to nearest: Well ------------------------------------Foundation .......-.............. Prop. Line ......................_1 <br /> LEACHING LINE [ ] No. of Lines ........................ Length of each line.-_..-..--__-__-_-_--- _-... Total Length ... ........................ <br /> 'D' Box ..-----..... Type Filter Material ....................Depth Filter Material ----------_--•_._- ._-__-.-....___...-._.--. <br /> Distance to nearest: Well ........................ Foundation ..... .................. Property Line ........................ <br /> SEEPAGE PiT ( ] Depth __--------_--__-_- Diameter ............... Number ............................ Rock Filled Yes ❑ No ❑� <br /> Water Table Depth -------•.............•••---•--•••-•--------.....Rock Size ................................ S <br /> Distance to nearest:.Well.........................................Foundation ...............:......Prop.-Line --................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---•----.---__ ____________________________`Date .................................. <br /> Septic Tank (Specify Requirements) ....... ----•-••-- -----------............................... .....................--.............. .................. <br /> is sal eld (Specify Requirements) , 1 ._r %- -hL �„�„••-_-- <br /> - ------------- <br /> -- ----•---------- ----- ------------------e------------------ ----- --- •...------...... .--- ------------------ - .. ---- --- ---- ..................... <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 Son 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 <br /> --------------- --._.:."�� ...... Title <br /> (If other than owner) <br /> _ _ FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- ............. ........................................ DATE <br /> BUILDING PERMIT ISSUED --------------------------------------------------------------- -------- ---- <br /> ----------------------- •- -------- •----------------------- -------- ---- •-----.....---DATE ........--•------------.---------=----- <br /> ADDITIONAL COMMENTS ......................................... <br /> ------------- ­................... ---......_....... <br /> �,..... <br /> EHFinal Inspection by- ---- ----------------_C_7......_....• ....................-•--•........-....-. _. ..'----------•------------._Date .-..�, l •-,7,S.. ....... <br /> 13 21a 1-6f3 Rev. 3 SAN JOAQUIN LOCAL HEALTH DISTRICT B/7 �M <br /> G� <br />