70-224 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. 7v ---------- --------------------------------------------- __------------ This Permit Expires 1 Year From Date Issued Hate Issued _ _ k::- v 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/LO TI N /VVA— _ -_ _ - - CENSUS Tt CT_ oOwner's Name Address ---P_61_ / `, City _ ,-� 1-Q -' Contractor's Name cense # , a -_----h-one Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court i❑ MotelL] Other ------------------------------•------------- Number of living units_____________ Number of bedrooms .��_______P.Garbage Grinder ------------ Lot Size - Water Supply: Public System and name ------------- _- -------- --------- - .-------- ----------------------------- •----------------------------- Private to Character of soil to a depth of 3 feet: Sand'❑ `Silt[] r Clay'❑' Pe_at-❑`-" `Sandy loam ❑ Clay Loam Hardpan ❑ Adobe Pg Fill Material ------------ If yes, type __________________________ y (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'[ ] Siz ------------------------------------------------ Liquid Depth -_-_------.--------------- 4� Capacity ----------------- Type -------------- ---- Material---------------------- No. Compartments --- ------.--•--- Distance to nearest: Well ------------- ---------------------Foundation ------------ ------ Prop. Line ---------------------- LEACHING --------- ------ J1 LEACHING LINE [ ] No. of Lines ------------------------ Lengt of each line---------- ------------.---- Total Length -----------_---------------- D' Box Type Filter Mater I ' . ------ -- yi? --------------------Depth Filter Material ---------------------------------........... - Distance to nearest: Well ___________ ____________ Foundation _._.___ ---------------- Property Line ___-___-_________...... SEEPAGE PIT [ ] Depth ___________________ Diameter _ ______________ Number _____.___________---____.__ Rock Filled Yes ❑ No .(3 Water Table Depth ------------- -----------------------------Rock Size ----------------------...._ 4� Distance to nearest: Well ------- -----------------------------Foundation -------------------- Prop. Line ...................... itEPAIR./ADDITION{Prev. Sanitation Permit# ______________ ____ ------------------�____ Date _________________.._._____________ Septic Tank (Specify Requirements) -----/J1� _!t ` ----_-Ove "--------- ✓j----e .............. ?�ie~iy Disposal Field (Specify Requirements) _ r. / /ice ..�,� / G .�.-�. /��- _ ------------------ ----------------- --------- --------------------------- -------------------------- (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 i 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 J as to become subject o Work n's Compensation laws of California." PP Signed --------- Owner --- ----------- ------------ BY ------ --------- -------- --------------------- (If other than owner) v �$ FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY k --- ------ -�' - DATE _ I-. "„ ----------- BUILDING PERMIT ISSUED ---------------------------------------------------------------------------DATE ------------- ------ ---------------------- ADDITIONAL COMMENTS - --------------------------------------------------------------- -------------------------------- ----------------------------- - --------------------------------- --------------------------------------------------------------------------------------------------------- ---------------------- -----„� _ -----------------------• =-- ----------------------- --------------------------------- --------- LI - �" • "- Final Inspection by: :Y- _ ••----------------•-- Date - SAN JOAQUIN LOCAL HEALTH DISTRICT