74-840 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT Permit No. . __-• (Complete in Triplicate) ................................ 7• - This Permit Expires 1 Year From Date Issued Date Issued .�_/.1�--'. Application is hereby mode 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 Or�diin/ance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT N . ../ �� ._.. �` -... .....CENSUS TRACT ..............:........... ..._ .....,Phone ....... ............................ Owner's Name Address . / -....-.. ................... ... City .---- p Contractor's Name ... . .. �� ,�/ �•--...F '"� ---.License # _.Phone .............................. Installation will serve. Residence 21"Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other q Number of living units: r-.... Number of bedrooms _..J.....Garbage Grinder ..... ...... Lot Size ........ ................. ............ Water Supply: Public System and name ._-•-------------__ -------------------------------- -- -..Private L� W Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam �ay Loam Hardpan ❑ Adobe ❑ 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 j Size`----------- ----------------------- Liquid Depth ................... Capacity .. Type --------•---. ------ Material-•.... ...... ....... No. Compartments .......... Distance to nearest: Well _ _ -__.._Foundation ................. --- Prop. Line ........-------- LEACHING . ....LEACHING LINE ( I No. of Lines Length of. each line ........... Total Length ------. ..................... 'D' Box .......... . Type Filter Material --------------------Depth Filter Material ...................., ----------- ......... Distance to nearest: Well ------------------------Foundation Property Line ............. SEEPAGE PIT [ ] Depth Diameter .--_-----•--••-- Number .,...... ._..--...--__ -- Rock Filled Yes ❑ No ._ Water Table .Depth -------Rock Size;`.. •--------•-••----••------• I Distance to nearest: Well ------------ -------Foundation .................... Prop. Line ....-__--____ ........ REPAIR/ADDITION(Prev. Sanitation Permit* ._._-___. ............... ----------------- Date --_-------- Septic -_-------Septic Tank (Specify.Requirements) ...... ...------------ ....................... .... ._.....-----............... ........................................ Disposal Field Specify equirements) ... ..... .... ._ _...._.__._. _ - A------ 2----l�-_ ---4- . ---- .-------/..- ---- ' (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. Nome owner ar 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 become subject to Work n's Compensation laws of California." Signed ---- ------ --- ---------------- Owner Title . a ..... : ............... . .................................. jy ..(If other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _----. DATE ._.....- .. - .... -.��...---.. BUILDING PERMIT ISSUED ----------..---------- --------- -•-- •. ----- -----. ......_......_DATE . ........ ADDITIONAL COMMENTS ............................................ ----•---------•------ ............ ......_.................... . ..................................... ............... -- Final inspection by: Date ......_ ----7�------ SAN JOAQUIN LOCAL HEALTH DISTRICT .7/72 3 ,�i