72-984 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - ---- --- -- - f p (Complete in Triplicate) I Date Issued �a'S--�L r This Permit Expires Z Year From vote issued -, mit to con Application is hereby made to the San com llianc c with County al Health tOrd Ordinance No. 549 and existing Rulesstruct and described. Regulations-. l the work described. This application is p � j]�f,, S . (""to-o AJ 'K !```CENSUS TRACT JOB ADDRESS CATION . ---- --- --- --Phone -------- --- -------- ------- Owner's Name - - ----- 1 /lx City ----------- Address ------ - Phone ------ ------------------ ------ --------- - - License # -�� Contractor's Name _ - - Installation will serve: Residence Apartment House Commercial ❑Trailer Court 0 -- Motel ❑ Other -----'- --------------------"---------- * 1 k i p� Number of living units:--_.-_ .__ Number of bedrooms . -_. .Garbage Grinder ---------.-- Lot Size - 'rivate ti 11 5 ~ !Sandy Loam ❑ Y I Water Supply: Public System an name --------------- -------------------- -- ----- - ; ? Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay y Peat❑ Y Clay Loam a Hardpan ❑ Adobe'❑ Fill Material--"-.__^ --- If yes,type -------------- size of lot, location of system in relation to wells, buildings, etc. must be placed ori, reverse side.) 1 (Plot plan, showing I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) I _ Liquid Depth ------------------•---- PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size---�'--------------------- ------ ------ ---- q p x Ca acit Type .-_.-------- Material---------------------- No. Compartments ------------- Capacity ------------ = Py ---------------- s distance to nearest: Well ------------------------------------- ------ ---------------------- Prop. Line ---------------, LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------- Total Length --- -------• Type Filter Material --------------------Depth Filter Material ------------------------- 'D' Box ------- " Y . r Line . ----•----- Distance to nearest: Well --..__..--..._.--_----- Foundation ------------ Pro pe -------------- Depth Diameter Number ---------------- Rock Filled Yes ❑ No I❑ SEEPAGE PIT [ ] P ---------------- ¢ Water Table Depth ------------------------- --------- -----Rock Size ------------------------ - . Foundation Prop. Line -- ----------------•-- ------------------ Distance to nearest: Well -".._------------ -------- - I . i Date ----------------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ) Septic Tank (Specify Requirements) ------------- --- -----------------------------------,----------------------- ._..._.-_,., Disposal Field (Specify Requirements] C.r� — -_ , - ' ' - ------ --------- --- -- - -------- ------------ ------------- ------------------- -------- -------- , (Draw existing and required addition on reverse side) i i hereby certify that 1 have prepared this application and that the work will be lone in accordance with San Joaquin Health District. Home owner or licen- County Ordinances, State Laws, and Rules and Regulations of the SanJoaquin Local 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 mannas as to become subject to Workman's Compensation laws of California." Signed --------------------- --------- -- ---- -- - - Owner --- ------ -- itle By (If other than owner) , FOR DEPARTMENT USE ONLY _.. -DATE / ��:' Z --- = -------- APPLICATION ACCEPTED BYy...__ -- ----------- - . - -- r . . �_ �.. ------ - -- ---DATE ---------------------------------------•--� ;. BUILDING PERMIT ISSUED ----------------------------------- -----y- _=-------- :",.�. . . ADDITIONAL COMMENTS ------------------------------------------------- ------------------------------------------------ ------------------------------------------------------------------------------ -- ---------------------------------- L- ---- ---------- ---- --- -------- --------- -------------------------------------------------- ------ -------.Date�.-- -- --r- - -j - Final Inspection b --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M