75-209 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - ----------------------------------------- APPLICATION FOR SANITATION PERMIT -4 -----_----I-------- --------- ------------------ (Complete in Triplicate) Permit No. ....._ 0 --------------------------------------- This Permit Expires 1 Year From Date issued Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h r described. This application is n�e i mpliance with County Ordinance No. 549 and existing Rules and Regulations: herein ! JOB ADDRESS/LOCATION. ._---_ S g 12RAt u. CENSUS TRACT Owner's Name i ' --- ---- ----------- -- Address --!2-d_ fJ Phone -------- ------------------------------ - --- ._ --10--- -----------------------------------------• City -- --. Contractor's Name ---- -------------- ----- ----- ------------------------ -- - ----.License # - Co to- ------ Phone Installation will serve: Residence partment House❑ Commercial:❑ Number of living units:----- Trailer Court 'El. i Motel El Other .Motel Number,of bedrooms.-------._Garbage Grinder --__________ Lot Size --_____ -- pp Y: ----`- Water Su 1 Public System and name -_ _--__--_ p - ----- ---------------------- -:�.: •: Character of soil to a depth of 3 feet: Sand Silt E •— }-Private Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ Hardpan obe, Fill Material ------------ If es P ❑ ' Ad . yes,type----------- (Plot plan, showing size oflot, location of systern``in relation `to wells, buildings, etc. =must'6e placed on r NEW INSTALLATION: [No septic tank or seepage-pit permitted if public sewer is available within 20 averse side.) PACKAGE TREATMENT 0 feet, [ ] SEPTIC TANK' [� Size-- ------ �- ---- - •l � ------- ------- ------ Liquid .Depth . �- Capacity -./-t�0------- T --------- -- Materia[_�Q tc�� Type<7/- -- --__ No. Compartments -- __•______ •._ Distance to nearest: Well /�Q___ '. r ------Foundation ---- LEACHING LINE LINE [� No. •of..Lines ------- �---- -------- Prop. Line -�1(7.---:------- --------- Length of each line------ 0--_---- ``ff ------ Total Length _-:�a� D' Box -i-L�S-- T - --•--------• Type Filter Materialo Depth Filter Material Distance to nearest: Well -----1 •... SEEPAGE PIT Foundation ---- r-_--------- Property Line 1Q `Q l Depth ------- Diameter -----------•---- Number ----- Rock Filled Yes ❑ No 0 Water Table Depth ------------------- _ ........Rock Size -------------------- bistance to nearest: Well -----______•___________ _ __ _ --•-------�. -- ------ -Foundation --------------- --- Pro Line ...-- REPAIR/ADDITION[Prev. Sanitation Permit# ______________________ ---- Date -----------------------------------} Septic Tank [Specify Requirements) -._-______ .- =---------------------------------------------------------•-------------•--- Disposal Field (Specify Requirements) 134> 21FRMri- ------------------�j-------�7D_-� -------------- �. -- ------------------- (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, I shall not employ any person in such manner as to becoe subject tp,Workman's Compensation laws of California." SignedBy - V?- --�"�-''---"c �/ ------------------------------ Owner 4 (If other than owner) --------------------•------------------------ Title ........ .................................................. _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _..---_I-i_Y'1�--------------------------------------------- BUILDING PERMIT ISSUED — r ` ------------------ ------------- ADDITIONAL COMMENTS -____ DATE ____ _ _____�f-------_------------ -- ---------------------------------------- DATE -- - - - - - �� -------------------------------------------------- --------------------------------------------- --------------------------- --------- - - � -- ------------------==------------------------------ tionb yFinal Inspec ------- _ --- , i ------------ -Date -- SAN JOAQU[N LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.