Laserfiche WebLink
FOR OFFICE USE: ��^i <br /> _.._`5_`� _ APPLICATION FOR SANITATION PERMIT <br /> 1/ -- /.. - <br /> (Complete in Triplicate) Permit No. ............... <br /> .. <br /> This Permit Expires t Year from Date Issued 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 ith Count Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIO � I -- --- ---- ..................................CENSUS TRACT ...................... i <br /> — 4 <br /> Owner's Name .......... -- •- - ----� - - ------•- - -. ..............................•--_................... ....__.. Phone .. .........._...... ......_-. . <br /> Address ' <br /> Q � <br /> - -- -- .. .. -• --•-- --:City _. .. ._ .........�':�................................. <br /> /� <br /> Contractor's Name .._.. _t_t.L.r._� a....�.__-- ---G-1�------: -s......License # ........................ Phone ._._........._....r_.._ _ <br /> Installation will serve: Residence[A�Apartment Hause0 Commercial ❑Trailer Court C] <br /> Motel ❑Other ---- ....................................... t <br /> Number of living units:.... Number of bedroom ......_Garbage Grinder ............ Lot Size ......9- <br /> Water Supply: Public System and name -------I'll................................................................................._................Private <br /> Character of soil to a depth of 3 feet:,...,Sand'E] Silt❑ Clay .❑ Peat❑ Sandy Loom ❑ Clay Loam <br /> Hardpan Q Adobe0( <br /> Fill Material ............ If yes,type ............... ............ i <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc:Imust be placed on reverse side.) � <br /> NEW INSTALLATION: <br /> (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ } SEPTIC TANK I ] Size................. .......... Liquid Depth --------------I................. <br /> Capacity P tY -------....•...----- Type --•................. Material...................... No. Compartments ....:......I'll.......ofa E <br /> --.Foundation ....... Prop. Line <br /> Distance to nearest: Well ----•--•---------•-•------._... ....:.......... ......................� i <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 ----..................... 1 <br /> SEEPAGE PIT [ j Depth -------------------- Diameter ......... Number ............................ Rock Filled Yes ❑ No 0` <br /> Water Table Depth ....................................-...........Rock Size ............................... Io I <br /> Distance to nearest: Well ....................foundation ._...._.._ ......... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permi . Date ...................... <br /> Septic Tank {Specify Requirements) ._. _._.....- <br /> � } j <br /> Disposal Field (Specify Requireme .. ®. ••. -----•---t--••---•--- ................. -_----_I............ <br /> ._. <br /> v=- - ------ ••----- - ------- <br /> �C �"' <br /> -. --- ----•--•- --------•--------•-•----. •-•.................................... ..........-... <br /> ,_ <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 Rales and Regulations of the San Joaquin Local Health,District. Horne owner or licen- <br /> sed agents signature certifies the following: <br /> N certify that in the performance of the worts for which this permit is Issued, 1 shall not employ any person in such manner <br /> as to beco a su iecFl orkman's Cam ..p tion laws f California." <br /> Signed _ -.�. �_-_ ----�� --�`. I. <br /> ... <br /> By ------ ------f-------------------------------------------- -------•--- . Jitle :... _.'_.......__�... ......................... <br /> ( other than owned <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION <br /> `— <br /> --- <br /> APCATION ACCEPTED BY ..._. . - -=-�-- -- ,_ - - ------------------------------------------------------•....._... DATE ---•���-Z-3 ---�-�....__.. <br /> BUILDINGPERMIT I <br /> SSUED -------------••--- ..... -----•-------•---...- ---...-•--------------------------••------..DATE ..................... <br /> ADDITIONALCOMMENTS ------------------------------------------------------- ------------------------------------------------ --- -_._......... ........ ----------•---------...__._ <br /> -------- -- --------------------------••---------- ------- -•------------------------------- ----------•------------- ...... <br /> _ <br /> ---•--------- ------------------ •- <br /> finalInspection by: ------ ..... ................................................................................Date /8;7 <br /> ---..__........_... <br /> EH 13 1-68v• SAN JOAQUIN LOCAL HEALTH DISTRICT b 3M W <br />