72-1169 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT -------------- ----------------------------------- (Complete in Triplicate) Permit 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI f_��___,_..___- - -------- n _ _ _- _____ -------------------------CENSUS TRACT p Owner's Name ----------------- _ - - ---------- Phone ------------------------------------ Address I ............... ----- ---_� City ��._-- Contractor's Name --____-- _ ---F_' --License Phone ..----------------------------- Installation will serve. Residence Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other ------------------------------------------ Number of living units: ------ Number of bedrooms ____„__Garbage Grinder ------------ Lot Size _____ Water Supply: Public System and name-------------------------------------------------------------------------------------------------------------- Private [ Character of soil to a depth of 3 feet: Sandf] Silt ❑ Clay ❑ Peat ❑ Sandy Loam Clay Loam ❑ Hardpan 0-- Adobe _,F] ,.Fill Material------------ If yes, type ---------------------------- r (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,) LN PACKAGE TREATMENT [ J SEPTIC TANK,[ ] ,' Size ---------- ------------•-----------.------------ Liquid Depth -------------------------- A Capacity -------------------- Type -------------------- Material--------- ----------- No. Compartments ---------------- ..... 001 Distance to nearest: Well ____________________________________Foundation ---------------------- Prop. Line ______________________ LEACHING LINE [ ] No. of Lines ________________________ Length of each line ---------------------------- Total Length -------------------_-------- __________-___-__..___-____'D' Box 'D' Filter Material Depth Filter Material ------------- ------- -------------- ____-________ Distance to nearest: Well ______ _________________ Foundation ------------------------ Property Line ________.________--.___ SEEPAGE PIT [ ] Depth ------- ___---------- Diameter ---------------- Number ----------------- .---- ----- Rock Filled Yes ❑ No C - Water Table Depth ----------------------------- ------------------ Rock Size ----------------- -------------- ' Distance to nearest: Well ----- ______T_____________' -_.-__....Foundation -------------------- Prop. Line ------- ...___-.__...-_ REPAIR/ADDITION (Prev. Sanitation Permit# ____________________________________________ Date __________________________________) Septic Tank (Specify Requirements) - Disposal Field (Specify' Requirements) --- ----��-c.------------- /-E70----------®.-,--------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ' ------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------- (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.- "] 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 become subject to Workman's Compensation laws of California." i Signed ----------------------------- 'a --- Owner , B °`. Title ..-!9`�it------ t------------------------ (If other thaenerl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ------.-- -----. DATE' ��_-7/'.--------- - - -- ------ ------------------------------- BUILDINGPERMIT ISSUED -_ ----- ------------------------------------------------------------------------------------------------DATE---------------------------------------- - ADDITIONALCOMMENTS--------------------------------------------------------------------------------------------------------------------------------- --------------------------- - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------ Final Inspection by --- --- -- ----------------------------------Date%,.7_-'1 ------ �/-- ----- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT { ,__ E. H. 9 1-'68 Rev. 5M.