75-470 - Laserfiche WebLink

Home Browse Search

FOR ©EPICE USE': APPLICATION FOR SANITATION PERMIT d p p Permit No. .�s..��•. . (Complete In Triplicate) This Permit Expires 1 Year From Dat*Issued Date Issued 6.`......:.... 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/LOCATION .........CENSUS TRACT ._./...�.�.�j..�. !(.-yJ Owner's'Name .. . . 7 ..........-.......... ................Phone e .. .............. Address . . ._.f.9��. . ....! .•- •.. City .......C�-�.. •0...,. ....... .� ,� Contractor's Name {� License 94` �' Phone .............................. installation will serve: Residence®Apartment Hou ❑ Commertial ❑Trailer Court Motel ❑Other ... ....................... Number of living units 7n------Number of bedrooms ............Garbage Grinder ............ Lot Size ....Q- 1 � ---------------- r Water Supply: Public System and name .........Private ❑- Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan 3/ Adobe 0 Fill Material If yes,type ' [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 see ge pit permitted if public sewer Is available within 200 feet,} PACKAGE TREATMENT [ ]r SEPTIC TAMCSize..i ./ -1� ....`'� Liquid`Depth....�,�/�.. ._ _ Material. No. Compartments 2..... J Capacity d_�.. TYPe �..... Distance to nearest: Well ---- 670 .......Foundation .... ..... Prop. Line ......,. ...o LEACHI—NG LINE (� No. of Lines -------)............... Length of each line......... ... Total Length ....Ya V Box ............ Type Filter Material ..._. _ ......Depth .Filter Material ....f .................................Z I f Distance to nearest: Well ...... 5-P-. Foundation ....1..0 Property Line J-AC ' SEEPACiI PIT De th �--`� Diameter �� g p ; ...__-. Number _..._..-.-1.__•---•-_ Rock Filled Yes No Water Table Depth .............. 1�.. ---......... `' ---..---Rock Size • �� .�✓ y, Distance to nearest: Well -------J,00- .............Foundation ....../.0-A.07 f Prop. Line .... ........ ..!� ... REPAIR/ADDITION{Prev. Sanitation Permit# ---.---..----------------------------------- Date ................................... l Septic Tank (Specify Requirementsl -------------------------------------------..................... ...............................................-.......... .__........__... DisposalField {Specify Requirements) ••-------------------------------------------------------------------------------------------------------•-- ......................... ----------------------------------------------- --------------------------------------------I------------...................................w......... ............................................ {Draw existing and required addition on reverse sidel I hereby certify that t 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;Dlstdct. 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, t shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." , Signed ..........---•------------------------ ------•- --- ----- -------- -- Owner � j ---- -- BY 'r �, _._. Title �� T`,...... ------- (if other than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------. P- -----------------------------•--------------••-- - --------------------------------- DATE ........ BUILDINGPERMIT ISSUED -..----•-- ----------------------------................... --•--------------------•-••------------ ------.DATE ----- -------------------.---------.---- ADDITIONAL COMMENTS ---------------------------------------------------- --- ---------------------------------------------: ------------------------------ - ------------------------•--•-•--••- -------------- -...... ----.------- --- • Final Inspection br..•--"-•--••-----....----•-----------------••---=-..:..... ---------.....-..........Date ........ _._?�r ...dam ......_.._ f ' EH 13 2h 1-68 Rev. 5M SAN JOAQUtN LOCAs. HEALTH DISTRICT