71-954 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ` w, APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. __. __ ---- ---- ------------- This Permit Expires 1 Year From bate Issued 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/LOCATION .- - _ _- ----xzf---_P,?- ----------------CENSUS TRACT _-- Owner's Name r� r� - •- E - --------------------------------------- ------ -Phone Address - --------------- city -. / Contractor's Name ----- _----- � �!�'-----------------------------License Phone�� - Installation will serve: Residence PdApartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other Number of living units:--- __.-- Number of bedrooms �---__Garbage GrinderAe- Lot Size 12 Water Supply: Public System and name -------------------------------- -----------Private6�` Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam "E Hardpan ❑ Adobe 9Fill 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 seepage pit permitted-if public sewer is available within 200 feet,) PACKAGE TREATMENT . SEPTIC TANK [ ---------- -Size----------------- -- --- Liquidid -0ePt`F''--------------y------------� --�_------ Ca acitType Material----------------___-- No. Compartments Distance to nearest: W --- ` ----- i --------Foundation -- t Prop, . Line -------- ofach` line--_- _---.-_:__ Total LengthLEACHING LINE No.-of Lines -------------- ------ Lengh -------•-----•" --------- 'D' Boxl------------ Type-F"dier•"Material - -----------------Depth Filter Material ------•:-------'- . Distance to nearest Weli ___-_-__�-- -- Foundation-- ------ ----__-- Prop erty Line SEEPAGE PIT - - -- [ ) Depth Diameter Number ` - ___-_ _-; Rock Filled Yes ❑ No 0 � Water Table Depth ------------------- ---------------------------Rock Size ------=-------------------------� Distance to nearest: Well ----------------------------------------Foundation ......_--_--------- Prop Line -------------__-„-•_: _ � 4 REPAIR/ADbITION{Prey. Sanitation Per It _----.-.-=--------------------------------- Date ---;---------_- Septic Tank (Specify Requirements) -------------------- ------------ ---- - - ------ --.-- Disposal Fi Id (Specify Requirements) _ __--_-, ____�^, "_ ��------��°i� /..� -, _� ,� ---- --------- -------------------------------- -- ----- ------------------------------------- raw existing and required addition on reverse side I hereby certify that 1 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 or licen- sed agents signature certifies the following: "I certify that in the performance of the work for whicOhis permit is issued, I shall not employ any person in such manner ' as to become subject to Workman's Compensati.on laws of California.” Signed --------- ------------- - - Owner -- ---------------- - -- By ------------------ -- -------- r --------------;------------- Title ------- 1f t��" of a an ownsr) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .__._--_�___ .. ------------------------------------------ ------------ - DATE _ 0.--------- i ------ BUILDING PERMIT ISSUED --------------------- ` -----•--_DATE - ----------------------------------------- - eF- ITIONAL COMMENTS ------------------------- tF ------------ -------------------r------ ----------------------------- ------- . -----------•----------------------- ----------- - ------------------------------- •------------------------------ --------------------------Final Inspection by: M ----------- - + -------- -------- -- Date ----------- SAN - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M E