68-977 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - 5 --------- --- ------------------ ------------------------ (Complete in Triplicate) Permit No: ------------- -------------------------------------------- Date Issued _ --------------------------- ---------__---__ This Permit Expires 1 Year From Date 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 N 549 and isting Rules and Regulations: JOB ADDRESS/LOCATION _!- > _ - ----- /�3 CENSUS TRACT --------------- -- Owner's Name ---� � '' "- , -------------------Phone ----. . Address �J �-�--'----------- -------- = City -_ - --- - ---- ---------- ------------------------------- -- T f p i Contractor's Name ------ f7 -"� /, ------------ -=--------License #l( ?- _ Phone � ': --• I Installation will serve: Residence)'Apartment House❑ Commercial ❑Trailer Court l] Motel ❑ Other -------------------------------------------- Number of living units:___-/_____ Number of bedrooms _,�?-----Garbage Grinder lvd-- Lot Size_-- --------------------- Water Supply: Public System and name _________________________ _ ___-_______----____---_Private Character of soil to a depth of 3 feet: Sand❑ Silt 0 Clay Peat❑ Sandy Loam .0 Clay Loam❑ r Hardpan [d Adobe-El Fill Material ___________ If yes,type ---------------------------- (Plot _____________________ ___(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 Size--X�-�_X-a ------ ------ Liquid Depth ------------------- Capacity tJ24?0____ Type " Material AC , No. Compartmentsr-____�:.... (Al Distance to nearest: Well ------.___ a-------------------Foundation ___1- -`----_-._._ Prop. Line __ ?' : ____-- p� LEACHING LINE No. of Lines ----A--------------- Length of each line .0f0-__---------- Total Length : ........ 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------------------------- Distance to nearest: Well ----4_07_`4__ Foundation -------------- Property Line --- _--.•.------•-•.--- SEEPAGE PIT Depth __ .------ Diameter -�j------ Number __________________-�_____ Rock Filled Yes No JQ Water Table Depth -------- 4 -----------------------------Rock Size - -------------- ---------- Distance to nearest:,Well _/_;L4?----------------------- Foundation e1 ---------- Prop. Line _-- =------------•---- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------- ----- Date -------------------- - ----------1 r Septic Tank (Specify Requirements) -------- ------- - ----------- --------------- - --------------------------------------- --------------- ----- ----------- ----•--•- Disposal Field (Specify Requirements) -------- -------- --------------------------------------------------------------------- --------------- O ---------------------------------------------------- ---------------------------------------------------- ------------------------------------------------------------ - ------------=---- ----------- -------------------- ------------------------------------------------------------------------------------------------------------------------------------ --- (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, 1 shall not employ any person in such manner as to become subject to Workman's Com ensation laws of California." Signed ----------- - ------I---------- ---- ------------------------------------- Owner i BY ----------------------- Titley' �� -- - ------ ---- - --------------- f Cher than owner) FAR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ _--- �__-. DATE 1l:"-- --~�� ------------------ ---- ----------------------------------------------------------------------- ----- BUILDINGPERMIT ISSUED ------------------------------- - -------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS --------------- ----------------- ------------------------------------------------- --------------------------- ----------------------- ------------------------------------------------------------==--------------------------------------------------------------------------------------------------------------------- ------- --•------- - Date fl --- ---------- SAN Inspection b -----------------------------�--------- -------------- --- ,- SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M " '