Laserfiche WebLink
FOR OFFICE USE: FOR OFFICE USE: , <br /> APPLICATION FOR SANITATION PERMIT <br /> P Triplicate) <br /> Permit <br /> (Complete in Tri <br /> Date <br /> ......---•-•--- ............ ....................... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to.the San Joaquin Local Health District for a.permitto construct and install the work herein described. <br /> This application"is-mode in compliance-with County,Ordinance No. 549 an' existing Rules and Regulations; <br /> JOB ADDRESS/ O TI C� �.' '` `� � .CEN,SUS TRACT............:..... .......... . <br /> .. <br /> Owner's Name._ ... .. uJ. <br /> rn ---- <br /> = ohs. <br /> .� .. ------.Cit �J. .-Zi �]-- -- <br /> Address....-- � {�/`--�..�-� - ''�j --- ---. <br /> - / �^ <br /> Contractor's Name..- / .LA. .. ...............License #-----------_---------- ---.-Phone. --3.....---..... ------ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Mote <br /> Number of living units. _....L 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 ❑ Silt❑ Clay ❑ Peat,❑ Sandy Loam e Clay Loam ❑M <br /> Hardpan ❑ Adobe ❑ Fill Material.. .... ....If yes, type..... ............ ........ <br /> (Plot plan, showing size of lot, location of system in relation to wells,lbuildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is,availoble within 200 feet,) R <br /> PACKAGE TREATMENT [ ] SEPTIC TANK `� Siz A' <br /> �+ ---•----------- ...........Liquid Depth_. -------- --- <br /> Capacitti - p - - - - C.Material_C�. No. ompartments -... F---------------------C <br /> .r <br /> Distance to nearest: Well---- .. ....... . . . . :-"R "-..Foundation-.. _-.-- .. _.. .-.._.Prop. '73 <br /> - <br /> -._.--------.--. <br /> LE ( ] No. of Lines... ...... . ........ -------Length of each liria............................... Total :Length .. .... <br /> r�t�� Cin G 9.11/ 'D' Boxje!4P_.._.Type Filter Materia�- 1�..-..Depth Filter Material.................... -------- <br /> Distances to nearest: Weil---- --- <br /> ...---- Foundation-_... 0 _.._......Property Line------------- <br /> SEEPAGE PIT E l Depth---.............Diameter----------_-----.-Number-------------------------------- Rock Filled Yes ❑ No❑ I <br /> Water Table Depth.---------_----------- ------ ------.Rock Size...........----------------- i <br /> Distance to nearest: Well----------------- ..-.......Foundation -------.....__. -.-....-.Prop. Line........................... <br /> REPAIR/ADDITION {Prev. Sanitation Permit#-------------------------------:,.----..---------.Date.---.-------------------- ---.-------------) <br /> r <br /> Septic Tank (Specify Requirements)...... .. . ... .. ... -................................. <br /> .---. <br /> Disposal Field (Specify Requirements)- -------------------- r ...----.-..------------ -- ------_.............. <br /> �. <br /> ----------•------------------------ ----------- <br /> {Draw existing and required addition on reverse side) t <br /> I hereby certify that I 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: <br /> "I certify that in the performance f th rk for which this permit is issued, I shall not employ any person.in such manner as <br /> to became s Workma o n tion of California." <br /> Signed.. . .. ..... ... .. ---- - ...Owner <br /> BY ----- -- - - Title-------------- <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----........ . --------------- -DATE :.. ."`--3. -- <br /> DIVISION OF LAND NUMBER.-- ------. . -------------------- DATE.---------------- --..... <br /> ADDITIONAL COMMENTS ---- - ..... . -_----- .. <br /> .............•---•........-......----- - ---------- - --- --- - - --------------- --- ---------- -- -- ------- ----- --•------------------ ------------ -• ----------------------- <br /> ..._i _ <br /> ---• ------------------------------------•--•---------------- -------------------- <br /> Final lnspecrion by ------ - -------- -- -------- <br /> ..-- - ---- - ....Date....... Y.. ....... <br /> EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT FSS 21677 REV. 7/76 3M <br />