73-552 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. __73...s S?— (Complete in Triplicate) --------------------------------------------I-------------- Date Issued --------��- ---• This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein t described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC - --------- - CENSUS TRACT -------------------------- ------- ------ -- Owner's Name .-- ----- - --- ------- ------Phone ------------------------------------ Address d City --- - -------------- ------------------------------------•----------------- - --------- - ---------- ---- _ ---------------License #` � -y- Phone ---------------------- ------- Contractor's Name ___ --- ----- ----- Installation will serve: Residence 0 Apartment House❑ Commercial ❑Trailer Court '•❑ Motel ❑Other -------------------------------------------- - Number of bedrooms ------ g -- ------ Number of living units:."""_!_" " Garbage Grinder __--"-__--." Lot Size "._-"_" -"-""__"�-�-"_""_- -----------Private, Water Supply: Public System and name ------------------------------------------------ ------------------------------------------------- Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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 [ I SEPTIC TANK,[ J Size----------------------------------------- Liquid Depth ---------------_--------- --------------------- -------------- ------------------------------- No. Compartments --------_------------ Capacity ----------- --- Type Material Distance to nearest: Well ------------------------------------Foundation—------------------- Prop. Line ---------------------- LEACHING --------- .------LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length -------------------------- t11 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ----------------------------------•-------•- O Distance to nearest: Well ------------------------ Foundation ------------------ ----- Property Line ------------------•----- _ SEEPAGE PIT [ ] Depth -------------- ----- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No • WaterTable Depth --------- - ------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation - .---------------- Prop. Line ---------------- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) -------- ---- -" ispos I Fi (Specify Requirem ts) - �" - ----.--_-- """ """" ) ^ --------------- - - ""Q ---'-----Y ----- --- --- ------ --- ---- -- - --- ------ - ------- -- - - -- ------ ---------------------------------------- M ----------------------------------------------------- -------- - - --- -- -- - ----------------------- r existing and required addition on r verse side) I hereby certify that I h ve prepared th s 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --? Owne BY -------------- - -- Title-_J -- ------------- -------------- --------------------------- (1f other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- " _ ------------------ DATE _.6-- "- - -------•- BUILDING PERMIT ISSUED --------------- ------- ---------------DATE ------------- ----------------------------- ADDITIONALCOMMENTS ---------------------------- - ---------------------------------------------------=----------------------- --------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- ------------------- ------------------ - " --- - -------------------------------- -------- ------------------- -- ----- ---- - Final Inspection b -------------------- ---Date G-- -ir---7 ---------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M