77-253 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ....................................... 1Cornplete In Triplieate) Permit No. ..7 7' 3 ........ ........ This Permit Expires t Year From Date Issued Date issued . :. .. 7 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 Regulation& may, JOB ADDRESS/LOCATION ..v2. .................CENSUS.TRACT ................,......... Owner's Name ...c ..- . __ .... . ._. --•......................................... .......... Phase ......... ...............I.......... X . . . . ... .._... ._...... -.... . '..........:................................. •---•-.Address ..__..._..... City _....... Contractor's Name �... �..,��,� ..............License ./�Y, ' Y.. Phone .............................. Installation will serve: I Residence C!Apartment House{] Commercial❑Troller Court 0 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: Sand❑ ilt❑ Clay [3 Peat❑ Sandy Loom 0 Clay loam El dpan Adobe 0 �Fill Material ............ If yes,type............... ............ (Plot pian, 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;l PACKAGE TREATMENT j ] SEPTIC TANK I ] Size_.......................:...................... Liquid. Depth .......................... • j Capacity -- Type ............ .... Material...................... No: Compartments ...................... r Distance to nearest: -Well ...:.:..::...:............. ...Foundation ... Prop.-Line Q LEACHING LINE j ] No. of Lines ...............7-_..... Length of each line............................. Total length ..............:............. 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................. Distance tc nearest;Well Property Line .-...................... Z SEEPAGE PIT ( l , Depth ---__------ ...... Diameter .............`•Number :........................... Rock Filled Yes ❑ No ❑ Water Table Depth .................... ........ Rods Size .................................... d Distance to nearest: Well ....................................-----Foundation ------------ ....... Prop. Line ...................... � REPAIR/ADDITION.(Prev. Sanitation Permit` -------------------------------------------- Date ...:.............................. } Septic Tank #Specify Requirements). ................... -•--=-- .................... ........... .................. ---- Disposal Field (Specify Requirements) ---,r... ---.....:........... -rip .................... 9- {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 lican- sed agents signature certifies the following- "I ollowing:"1 certify that in the performance of the work far'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." Signed -- -------•----------------------- Owner n By ----------- ........... .. �itle� Vic. . u1 .................... (lf other than owner) FOR DEPARTMENT USE ONLY •.. APPLICATION ACCEPTED BY ..___-�--- ---_--.._. BUILDING 'PERMiT"ISSUED ------ ----- ......... DATE ..3- 2- =`l_ •.................: ADDITIONAL COMMENTS ............ ... ... ..... . ..•- ________________________________________________ _____ ________________________________________________________________________-:-__..-.._._. _....... .....,....__......._- FinalInspection by: --- -•----------•--------------•-•--•• ---•--•--------_ ------------ --------Date� -2� •�...... .................. EH 13 24 -1-68 Rev. �AN JOAQtiIN LOCAL HEALTH DISTRICT 1STRICT 8/74 3M