72-1131 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: s ��,�� APPLICATION FPR SANITATION PERMIT -- (Complete in Triplicate) Permit No.. Issued Date This Permit Expires 1 Year From Date Issued Da �------•� 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/LOCATION . a ----------- ------------- _____________________CENSUS TRACT Owner's Name -- - ----- --------------- -- ---Phone Address --- - f------------------------ Y T `--------------------------- ------------- Cit -------- ------------------------------- Contractor's Name ---------- ------- License # /-M-5/1------ Phone ____W_? Installation will serve: Residence IxApartment House-C] Commercial ❑Trailer Court i❑ Motel ❑Other ' �f r ' Number of living units:----'------ Number of bedrooms ___ ------Garbage Grinder ------------ Lot Size _7-S___1C-- - _>S-G-O------ Water Supply: Public System and name ----------------------•------_ ------ ------------Private El- --------------------------------------------------- - -- Character of.soil-to-a-depth.-of 3 feefi: Sand.'❑ Silt E]. Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ 1 Hardpan ❑ Adobe Fill Material ------------ If yes, type ____________________-_-_ - (Plot plan,,showing size of lot,docation of.system .in elation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: i _ (No septic tank or seepage pit permittedr_rf public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ---- _ -_--_ � - - --------------- - -------- ---- Liquid Depth .----------•-•-------•-•-- Capacity ------------- Type ------- - '>'Materigl-- ------ No. Compartments -------------------- Distance -------• -Distance to nearest: Well ------------------------------- =-JFoundation ---------------------- Prop. Line ----------- .......... LEACHING LINE [ ] No. of Lines __---------------------- Length of each lie.:_.-''_"`=----------------- Total Length ------------- D' Box ..______- Type Filter Material ___________________ Depth Filter Material -------------------- ' IDistance to nearest: Well ________________________ Foundation ------ Property Line ----------------------- i SEEPAGE PIT [ ] Depth -----------'---_ -- Diameter --------------- Nu ber -------------_-------------- Rock Filled Yes ❑ No I❑ !Water,I Table, Depth ----- '-----r------- _.::_: : ..._Rock Size Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ................._ REPAIR/ADDITION(Previ Sanitation Permit# -------------------------------------------- Date --------------------- ------------ Septic _--_--_-_____---__- _____-------Septic Tank (Specify Requirements) _____._._ ' p '` � Disposah, Field (Specify Requirements) _______________(�--(, -- _----'�C1 ///��, f { tP , , _____ _ __ F � , k,-� •yyyIIIJJJ�if ____________________________________________ l ------------ 3 X 4 � ------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------ i (Draw ex4isting and required addition on reverse side) I hereby certify that I-have prepared this application and_that_the�woi Vk`11 be'-done in' accordance wifh-San Joaquin County Ordinances, State 'Laws, and Rules and.Regulations of-the San Joaquin Local Health District. Home owner'ar licen- sed agents signature certifies the following: -"I certify that in'the perforeance of the work-1oi- which this permit-es issaed, I shall not-employ any person in such manner as to become subject to Workman's Compensdtion laws of California." Signed --------------------- Owner - -- ------ - -- - ----- --------------- By ------------ - BY ----------------- -- ------ ------ - ----------- ------------------- Title ---- _ ---- ----------------------------------------------- (If of er t n owner] , TMENT USE ONLY APPLICATION ACCEPTE BY --------- - - BUILDING PERMIT ISSUED - ------ -- - - ---- ---- ---- -- ------ - --------------------- ------------------------------ ------------------------------- - - ADDITIONAL COMMENTS - __. -------- ----------- - --- --- -- - --------------------------------- -------------- -- ---------------------------- -- `� -------- ---------------- - - -------------- ------- - - ------ -----------------�- ---------------------------------------------------�----.----,-- ------------------------------ ----L---�----=-'----�--�-------�----x----�- --------- ----------------Fina( Inspection by D---------------------- ------------------------------ ----- - SAN _ JOAQUIN LOCAL HEALTH DISTRICT E. W 9 1-'b8 Rev. 5M