71-658 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r ----- ;>-"---- - ------ --=--------•------------- APPLICATION FOR SANITATION PERMIT Permit No. 7i---�--�-- (Complete in Triplicate) ------ --- --------------- -4 . 1 - __ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIONf',�� ---------------------------- -- ---------------- ---._CENSUS TRACT 5 •------•---- Owner's Name ---- ,ft�-e-------- -0'=--`-�-- ----- ---------------•-----•--------------------•------------------ •-------------------Phone ---------------•--•----------------- Address al- -r - City0�'�''� ' Contractor's Name i u------------------------------------------------------------- _;-------License # -------- --------------- Phone ---------------------•--•--_- Installation will serve: Residence ❑Apartment House❑ Commercial-F -E1 Court ;❑ Motel ❑ Other -----------------------------------•-------- Number of living units:____----- Number of bedrooms =__3-_--.Garbage Grinder ------------ Lot Size __________________-__-__-__-_____----.--. Water Supply: Public System and name ----------------------•------------------------------------------•-- .----------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt 1] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam rjK Hardpan Adobe-[] Fill Material ------------ if yes, type --------------______________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth --------------------------- Capacity ___________. r Capacity ---- ---- ---------- Type -------------------- Material---------------------- No. Compartments ----------........ >...: Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---.------ ............ LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length -------------•--------------- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------------------------- h Distance to nearest; Well ________________________ Foundation --------------- -------- Property Line _________.___-.-__-_-.-- i SEEPAGE PIT [ ] Depth ____________ _______ Diameter --- ------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth -------------------•---- -----------------------Rock Size ---------------------------•---- Distance to nearest: Well ----------------------------•-----------Foundation -------------------- Prop. Line ...................... REPAIR./ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) ---------------------------------------------------------------------- --•------------------------------------,------------ --------------- Disposal Field (Specify Requirements) --C ___ _ -- _______ Q_ - �'_ --:_3 t1'+r 11 1.ei ----- - ---------------------------- �- -------- -------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done•in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become su jest to Workman's Compiensattio_n laws of California." Signed _ -Q') " ------ Owner BY -------------- ------------------------ ------------ ------------------------------------------------ Title ------------------------------ -- - (If other than owner) //�� FOR .DEPAItTMENT USE ONLY APPLICATION ACCEPTED BY -----SCJ- - ---------------------------------------------------------------- DATE _6_"_ _-7/--------------------------- BUILDING f.-------------------------- BUILDINGPERMIT ISSUED -------------------------------------------------•---------------------------- ------------=--------------DATE ---------------•-----------I--------------- ADDITIONALCOMMENTS ------- ------------------- ---------------------------------------------------------------- --------------------------------------=--------------------------- ------------------------------------------------------------- - ------------------------------------------------------------------------------------------••----•---------------------------------- ------------------------------------------ ---------- -- ---- --- ----------------------------------------------------------------------------------- -- - ----- - Final Inspection by: ----------._Date -- - /- ` -� - SAN JOA QUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.