70-76 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: ' ------------------- ----------------------- (Complete in Triplicate) I� Date issued 'l�-�Q �! This Permit Expires 1 Year From Date Issued ---- ------------- --------------- Application -------- ---- Application is hereby mad,e 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/LOCATION -_ --------`--�'b �--------- ------- p - ------CENSUS TRACT = ---------- - ---------- - - Owner's Name _.__ ----------------- Phone--- ----------------------- �� city 3 Address ------------ ---------------- p ------ Contractor's Name -- ----- •-•---- -- License`# - 4 hone Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- L Number of living units:___ -)----- Number of bedrooms ___ Garb'a a 9Grinder ---------Private _ .. - ot Size ___t___ System -- ----- - --- --- --- F Wafter Supply: Public S st�m and name I Character of soil to a depth of 3 feet. Sand'El Silt❑ Clay ❑ Peat❑ Sandy Loom Clay Loam.D Hardpan E] Adobe'❑ Fill Material ------------ If yes,type ----------------------------- i� bildings, .etc. must be placed on reverse side.) (Plot plan, showing size,i f lot, location of system in relation to wells, u NEW INSTALLATION: (M,o septic tank or seep a pit permitted if public sewer is available within 200 feet,) i PACKAGE TREATMENT ['�] SEPTIC TANK'( ..,, Size___--ll�=�-/V---'r------"------ - Liquid Depth .-�--------------------- � Capacity . 7-- 6- Type ----------------- Material o. Compartments _-A---------- Distance to nearer : Wel! ,.S"O_�_______- _"--Foundation ____.l__o_�- ----- Prop. Line _-_�-- i-- ------ -- j9Q--i------------ Total Len th :" --d Len Length of each line � LEACHING LINE [ t�o. of Lines 9 -- ^ it �b. -L Aa—t --•---. I Depth- Filter Material ____________ _____ 'D' Box _=---_._--Type Filte��Mrateria _-.____•-"----;-fir¢ P Foundation I Property Line Distance to nearest: Well -.=----s----------- R � - }Diameter ------ ------ Number ------•-------- ------- Rock Filled Yes:❑ o ! SEEPAGE PIT [ 1 Depth ----------------- -- -�—�— it .v I -Rock Size ------------ - —Water Table:Depth:------ ------------------------------ if -Foundation Prop. Line Distance to nearest. Well ----------- ----------------------- REPAIR/ADDITION[Prev.;;Sanitation Permit# ---------------------------- - ------------ Date ----------- ---------------- ----------------------------------- --------------- ) Septic Tank (Specify Requirements) --------- ----------------------------------------- f ----------------------- Disposal Field (Specify Requirements) ---------------------------------------------- I !1' ---------------------------------------------------------------- ----------------------------- ------------------------------------ ----------------- ----------- ---- Draw---- --n and required ad' ----------------------------- ---------------- dition on reverse side) t � [ g a 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 becoLesubject to Workman's Compensation laws of California." , Signed it , V �. . ; _ Owner ------------ ------- -- Title By ----------- :- - - -------- - I (If other #Pian owner) I� 'FOR DEPARTMENT USE ONLY 9 7v ------- ------------ ----- DATE _�-�-�- -------- ----------------------- APPLICATION -•----- ------------ APPLICATION ACCEPTED BY _ �-�>� - DATE ---------------------------- -------------- BUILDING PERMIT ISSUED ---------------------- -------------------- t -------- -- -- ------- ---------- - --------------------------------------------------------------------------------- ---- ADDITIONAL COMMENTS ______________________ -------- -- ----- ---------------------------------------------------------------- ------- --------------------------------------- I---------------- ---------------- ----- ------------------ --------- ----- U------ - bFinal Inspection ------ -- ------------- ------------ --- Dae ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT f E. H. 9 1-'68 Rev. 5M.