Laserfiche WebLink
FOR OFFICE USE: <br />APPLICATION FOR SANITATION PERMIT° 7 <br />IComplete in Triplicate) <br />Permit No� !-:: . <br />This Permit Expires 1 Year From Date Issued <br />tFuh a�d! f <br />Application is hereby made to the San Joaquin Local Health District for a permit to cos Ins t the work herein <br />described. This application Is /made in compliance with County Ordinance No. 549 an existing Rules and Regulations: <br />JOB ADDRESS/LOCATION-l/--Di--.../.!!..U.R/itN.....................................................CENSUS TRACT ......................... <br />Owner's Name ..��.,�1.......f'.aQ,JJIl4 e./t%..............................................._..........................Phone .... .... ... .......... ......-.-...- <br />Address`l /......_..... ............... City ......... ..,... ...... I ............... ............... <br />Contractor's Name ..../ (.Clf}►lC ...: .............................. #........................ Phone 9,�it;�11.2......... <br />. <br />Installation wilt serve: Residence ® Apartment House{] Commercial pTraller Court r-1 <br />Motel [] Other .......................................... <br />Number of living units..-. ----- ... Number of bedrooms .a2......Garboge Grinder .. f......... Lot SizeP....**.. �� ......,. <br />Water Supply. Public System and name--............................................_............_......_.._......................................Private <br />--• <br />Character of soil to a depth of 3 feet: Sand r] Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam <br />Hardpan Q Adobe] Fill 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.) <br />NEW INSTALLATION. ;No septic tank or seepage pit permitted if public sewer is available within 200 feet,) / <br />PACKAGE TREATMENT (j SEPTIC TANK Size.... ............ Liquid Depth .'l�. ............. <br />Capacity yp r' ' Material.Gatz No. Compartments - A' .............. <br />l <br />Distance to nearest: Well ..1 ........................Foundation %d ............ .... Prop. Line ............0 <br />LEACHING LINE X1 No. of Lines .... Length of ch Ilne.�..... Total Length 9.0.. <br />D' Box'" � <br />Type Filter Material .`,....._..Depth Filter Material ...�� ............................. <br />'4 <br />Q <br />Distancenearest: Well _......%.�....... Foundation .../..d ............... Property line .�............ <br />T( ...... <br />1 <br />SEEPAGE PIT �j Depth ...� Diameter 3�.�....._. Number ....�..................... Rock Filled Yes_jUr No <br />Water Table Depth ...... ...---• ..................••.....Rock Size .. .�f'................ <br />Distance to nearest: Well .... r6...........................Foundation ...../4......... Prop. Line ..-......... <br />REPAIR/ADDITION(Prev. Sanitation Permit# ........_ .................................. Date ._. .......................... ----_j <br />SepticTank (Specify Requirements) :................................................................. _... .... ................................... .................. <br />DisposalField (Specify Requirements) ------------- .............. ............................. ....... ........ .----.................... . ................. <br />------------------------------------•-------- ................. ....................................... .............. .............................................. ......................... <br />.. <br />...--------------- --------- - ----------------_.................--•---........... <br />{prow 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 Sart Joaquin <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health. District. Home owner or Ikon- <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 becom bject to brkma pensation laws of California." <br />Signed_rXl.............................. .........._---_._ Owner <br />By-------- ------------ ..........-----•--- — Title ... -----....-. <br />(if other than owner) <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY_ .. z .b�►-, .----:,= DATE y-/? -?. _ .... .....:..: <br />BUILDING PERMIT ISSUED ..._.......... ............. . ---- ..._....• ...........DATE .... ..................................... <br />ADDITIONAL COMMENTS ............................... ................... .......__....._.._..._..,....... <br />............... <br />-------- - ------------•-••-----.......... f� _ _ <br />Final Inspection by: - ..................... Date Date ...7-. l .. ....... ......... <br />EH 13 2It 1-6E3 iZev. SAN JOAQUIN LOCAL HEALTH DISTRICT 3M <br />