Laserfiche WebLink
[-�R OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> P <br />. ..........................................t��: ..... <br /> e it��l <br /> ..)Complete In Triplicate) - <br /> .............:... .....::._::......::._.::_...::_-.::... p to Issue <br /> Da d C / <br /> This Permlt Expires f Year front Date Issued <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 i#h County Ordinance N . 549 and exit g Rules and Regulatlotlst <br /> C. <br /> . ... t�.�:�e.�... ..... .. ......�'.`�.... sus TRACT <br /> JOB ADDRESS/LOCATi �... ?......... <br /> -S. .........:....:................Phone .... .............••. <br /> . . <br /> Owner's Name 1-�nk.�P-+......_.�-.`�'•-Y�- --`�-:...............:.��.._..� <br /> Address :, - -�5 ..... ......city .. .. ... ......-•----••... . <br /> Contractors Name __ ��-•"•�=- <br /> �: •-----...-•-•-••• nse # ..r �� . . Phane ..__... <br /> k Installation will serve: k Residence(IApartment Nouse mmercia)❑Trailer Court fl <br /> Motel ❑Other <br /> ......................... <br /> Number of living units:_.....-_ Number of bedrooms Garbage Grinder Lot Size .......................................... <br /> Water Supply: Public System and'name .. ........................ .................................Private ❑ <br /> Clay Loam <br /> f Character of soil to a depth of 3#eat: Sand t3. Silt© Clay ❑ Peat❑ Sandy Loam ❑ y [I <br /> lHardpan[ Adobe or Fill Material ............If yes,type ............... ............ <br /> (Plot pian, showing size of lot,.location of system In relation to wells, buildings, etc. must be placed on reverse alae.) <br /> f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK I I Size............. ...................-:'"-'="==•....41quid Depth .-----............. <br /> f' Material...... <br /> ...•--- No. Compartments <br /> Capacity .............. <br /> .................... Type ............- <br /> . 1 <br /> Distance. to nearest: Well ...................Foundation ...................... Prop. Line ....................-. <br /> E " ... Total Length <br /> LEACHING LINE I ) No. of Lines Length of each line---.................... ....._... <br /> 'D' Box. ............ Type Filter Material .......Dep#h filter Material ....... ....................I........ <br /> Distance,to nearest: Well _............... Foundation Property Line ---.:.::.-•••••.......-- <br /> SEEPAGE PIT � ) Depth :--._.-- -__ . ... Diameter --------------:- Number `---...---.- .-......... Rock Filled Yes 0 No ❑ <br /> Water Table Depth Rock°Size •••--•- <br /> --•--......._ <br /> i I ' Prop. Line <br /> Distance to nearest: Well ............Foundation:................... ......._...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ....................•-••........--•-•-_...__ Date ----•------ •------•••------) <br /> Septic Tank (Specify Requirements) ............. .........•--•--.-------•-••--•-------....•• ------•----- <br /> ..... .._ ..._.__. --r/ _4 / <br /> . Disposal Field ecify Requirements) `.... -- 1 - <br /> b ............................................................------------­------------- <br /> ._..-----_-. --_-------. ............................................................. <br /> ...................................... <br /> --------------------------------- �. (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that-the:wont-wiii be done in accordance with San Joaquin <br /> County Ordinances, Stat® laws,'and Rules and Regulations of the San Joaquin Local Heiilth:District. Home owner or licen- <br /> 6 sed agents signature certifies the following: <br /> i "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 /> i as to become subject to Workman's Compensation laws of California." <br /> % � _ - wnSi ned _-------- ----- ----- •------- ------- <br /> =" - <br /> - Title ---------------- •• ------ .....___-- <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.----- --------- ------------ DATE__..._. . . . .._.��.------- ---= <br /> ------- - - <br /> BUILDING PERMIT ISSUED -------- -- -- -- •------ __. .. DATE _... <br /> ADDITIONALCOMMENTS ------------------ ---- -- .................................................................---•---,--- • ..............---------------- <br /> +. F i a »__ y ` - --•....................... <br /> ... --- ---------- _.... <br /> �. e <br /> ------------ -------- <br /> J . .. <br /> Final Inspection b Date -. ._.. . -- <br /> P Y -------------------•-_.----- <br /> EH 13 2}� 1-bf3 rt. ,;� SAN�t(?AQUiN LOCAL HEALTH DISTRICT 8/743 <br />