71-908 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- -- ------- - --------------------- Permit No. _7��--q--v (Complete in Triplicate) ----------I----------------------------------------------- This Permit Expires 4 Year From Date Issued Date Issued _�_"_2..9.71 5 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/LOCATI N �_�� ----- „---- � r ---- -------- ---------------CENSUS TRACT -------------- ------ e�WOwner's Name ----- --------------Phone --------------------- Address ' - ------- ----- ------ City -- y ----------------------- Contractor's Name --- _ _-- -- - -- --- --- ------1 icense #�lr _ Phone ------------------------------ Installation will serve: Residence Vf'Apartment House�❑ Commercial ❑Trailer Court ❑ Motel ❑Other ------------ ----------------------------- Number of living units:-----/----- Number of bedrooms ______Garbage Grinder ------------ Lot Size --------------_-------_---------------_ ---- Water Supply: Public System and name --------------------------------------------------------------------- F Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam 'El", Clay Loam ❑ i Hardpan ❑ Adobe ❑ 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 seepage pit permitted if ublic sewer is available within 260 feet,) PACKAGE TREATMENT [ I SEPTIC TANK f Size- .1 ...... - -.. ________ Liquid Depth __._ Capacity 41"------ Type - -- Material--- No. Compartments -- ------____-• Distance to nearest: Well -----------_6._°_)_________________Foundation __1O_--_________- Prop. Line -----_4 ----_________ � LEACHING LINE [e"No. of Lines ------v" Length of each line--------/0Qf__.______ Total Length _ ± ?.. -___-- 4�1 'D' Box _Inearest: Type Filter Material ___9. e_____Depth Filter Material ________r1X_ ---_,______________________ Distance Well _____.,�� _f_ Foundation ------497 -------- Property Line _-5--------•---•----- SEEPAGE PIT [ Depth .'___ ..i -'--,. Diameter _�__�i--- Number _.-------_� --___-___ Rock Filled Yes (� o ❑ f Water Table Depth ------- ------kD---------------------------Rock Size .�� Distance to nearest: Well ----------La49---------------------Foundation -----/_0 Prop. Line __s_ REPAIR/ADDITION(Prev. Sanitation Permit# ---___-._-_.____.._______________-_-- Date ________________________________) Septic Tank (Specify Requirements) --=----- ---------- ------------------------------------------------------------- --------------------------------------------------------- Disposal Field (Specify Requirements) _-_----_____ ----------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------•----- ------------------- ----------------------- - - ------------------------------------------------------- (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 r 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, I shall not employ any person in such manner as to become subject to7Wan's Compensation laws of California." Signed ----- -- --------------- -- ------------- - - Owner By -------------- -- --------------- ---------- Title (lf other than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------- ------------------------------------- --------- ------ DATE __Q_ '_ �---------------- BUILDINGPERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ----- ---------------------------------------------------------------------------------------------------------- ---------------------------------------------- ------------------------ C- Final Inspection by: ------------------------------------------------- -------------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM