Laserfiche WebLink
FOR OFFICE USE: <br /> '� '�- kj, APPLICATION FOR SANITATION PERMIT <br /> - - -------- l <br /> --------------- (Complete in Triplicate) Permit No. <br /> ----------I------ --------------------------------------- <br /> r This Permit Expires i 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 /> r-- <br /> described This;applicatlon,is,made in compliance with County Ordinance No. 549 and, existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ---' r.-�-!_ w�- �D-a.t---_-�--Iry----- ---CENSUS TRACT <br /> Owner's Name r <br /> ff <br /> . 'j- -rte_r- -1,�, . hi- �-�----.------------------ ----- <br /> Phone --------- -----•-------------------- <br /> Address -------------------- ---------13*'.- 1-- 2f l-. ................... City ---- 4i <br /> Contractor's Name ------------------` -_ _ --_.License #12 .. Phone '7-_CZS'_� --- <br /> Installation will serve: Residence kpartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other <br /> Number of living units:------L Number of bedrooms/__---_�---Garbage Grinder''<�f- Lot Size 1 --------------- <br /> -----•- ------------------------•----r- <br /> -- ---------- - --------- PrivateWater Supply: Public System and nam ------ ❑ (N <br /> Character of soil to a depth of 3 feet: Sand'[] Silt[] Clay E] Peat❑ Sandy Loam •❑ Clay Loam ❑ �7 <br /> Hardpan ❑ Adobe '0ill Material ,4L10 If yes, type --------k------------------` <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 [ I SEPTIC TAN7K'[],] Si_ze--_ Liquid Depth-- . --------- <br /> Capacity/._ ��/� yp <br /> T - Material ---- -..� .,- lo. Compartments --- -=.-•--•--• <br /> Distance to nearest: Well ----------ex <br /> ___________Foundation __ ----------- Prop. Line _o -- --.--_---_-. <br /> LEACHING LINE rk V No. of Lines ---'.rl..------------ Length of ch Iine_��j__��-;-- Total Length . �.;W__1-_.--_.---- <br /> 'D' Box - ( Type Filter Material Depth Filter Material .---.-__--- <br /> Distant to nearest. Well ---------__ Foundation __ -- ------- Property Line. ------------- <br /> SEEPAGE PIT Depth --4--__-_-- Diameter , - _._--_--_ Number --__--_. ----'---- Rock+ filled 'Ye� No ❑ <br /> y, <br /> z_ 'k _ <br /> Water Table Depth ---------6_�_ ----------_ Rock Sizef/.--- <br /> v- I - <br /> Distance to nearest-. Well -- -------------------Foundation __ -_ -__-- Prop. Line . -`....-.____- { <br /> REPAIR/ADDITION(Prev. Sanitation} Permit# -------------------------------------------- Date ----------------------------------- <br /> Septic <br /> ------..._------_---_----Septic Tank (Specify Requirements) --------------------------------------- -------------- - i <br /> Disposal Field (Specify Requirements) ---------• ------------------- = s = <br /> -------------------------------------- _----------- -- ------------------------ ---- -------- _ ------------------------- .., -------------- -- ------------t ---------•---- <br /> --------- ----------------------- ----- -------- - -------- --- -.-- ----------- --.----------------------------------------- -- - --------------------------------------------------------- <br /> I (Draw existing <br /> -and required addition on reverse side) <br /> I hereby,certify. that 1-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. San Joaquin Local Health District. Home owner-or licen- <br /> sed agents signature certifies the-following: f , <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any-person in,such.manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -------------- <br /> - ­-----------Owner_:,•,_ .,. <br /> BY ----------------------- ; ' ---- ---------- Title <br /> {I of an owner) <br /> �f- -------------------- <br /> ' l i F, EPARTMENT USE ONLY ► <br /> APPLICATION ACCEPTED. BY ---- --- - ' -� --- --- ---------------------------- ----------------------------- DATE - =�� - r' ; <br /> BUILDING PERMIT ISSUED - -- ---- - --------- - -------- --------------------------- ---DATE -------------•--------------- ---------- -- <br /> ADDITIONAL COMMENTS ------ f -- =----- ----- --- -------- --------------------- <br /> ------------T--------------------------------------------------------- <br /> ----- <br /> -----------------------------------------•-----------------------------------•---- <br /> --------------------------------------------- ---------------------------- -- -------- - ------------------------- - <br /> r <br /> Fina Inspection by: =-------------=------- ----------------------Date --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. 5M '` <br />