68-1103 - Laserfiche WebLink

Home Browse Search

►r5 FOR OFFICVSE: 5- - - %/ APPLICATION FOR SANITATION PERMIT ►-_ Aa,� �7 D - (Complete in Triplicate) Permit No. _ ��/CIS � � P P ------- --.--_ This Permit Expires I Year From Date 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 compliggice with fountOrdinance No, 549 and existing Rules and Regulations: SrJOB ADDRESS/L ION .-!__ _�----_ � �- --- - - —'----------------- ----------- - --------CENSUS TRACT Owner's Name __ - --- 7f Address ,� w,, Cit -------Phone �� / Contractor's Nam - f---- 1-►---Zc--- ---------.License #(�--Y&, ---- 'e-A.----.----.---.- Installation will serve. Residence ( partment House[) Commercial :❑Trailer Court i❑ Motel ❑Other ------------ 1 / i- Number of living units:.___ ._-__-- Number of bedro - -.Garbage GIder _ _ V,41e_� of Size -4 - _! 2 Water Supply: Public System and:name.__,_-___-__- - �� ,�- I -- -- --------------------------Private ❑ ------ -- ------------ Character of soil to a depth of 3 feet: Sand❑ Silt Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam .I❑ Hardpan ❑ - Adobe Fill Material---------- If Yes, type -------------------------- -s:yti (Plot plan, showing size of lot, Location of system in relation toy v✓ells, buildings,-etc. must be placed on reverse side.) NEW INSTALLATION: •,',t F 41 (No Septic tank or-seepage�pit-permitted lf`public sewer is available within 200 feet,] PACKAGE TREATMENT [ ) SEPTIC TANK'[ j s Size-------f---=--------- ------------------------- Liquid Depth Capacity ------------------- TYpe `------------------ Material---------------------- No. Compartments Distance to nearest: Well ------------------------------------ - s . Foundation . --- Prop. Line LEACHING LINE [ j oNo, of Lines -------- Length of each line---------------------' Total 'Length :----..----. 'D' Box -__- ------- Type Filter Material __ i'"`" _`—Depth Material � I )•. ` 3 Distance to nearest: Well ----------------- ---- Foundation --_.--------------____-- }Property Line ------------------ ---- SEEPAGE PIT [ j Depth k. _7 I Diameter NiJmbe�- -----------------. --- Rock Filled Yes ❑ No I❑ — _ Water Table Depth ---------------------------- 1-1 � ' "" I --- Rock Size ,r' _ Distance to nearest: Well Foundation -----------------------.---- 'Prop. Line -- --------------- Septic ...,. ,.-..} _------•-,-.--REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- _ Date ---- Tank (Specify Requirements) j l Disposal Field (Specify Requirements) _ .. * ` ` -----_ -. ------ �-- -- ---•--- .. ------ ---- ----------- ----- [DrtSw existing and required Xclition on everse 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 I cen. sed agents signature certifies the following: 1► "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 be a ubject to VV7o rkma 's C Pens of lifornia." � Sig 1-f' --- --- --- -- ----- �- - ---- C2Oar�ae� til BY --- - ---- ---------- ----- Title- -- - --- --- - --tf- - ` [If other than owner} -----"- --------- -----�- f FOR DEPAIITMENT USE ONLY rr APPLICATION ACCEPTED BY C `-------- - =�'f - . - ------------------------------- - DATE _!-. BUILDING PERMIT ISSUED __-"-------------------------- --?-----"------ ADDITIONAL COMMENTS ---------- --------- - - - -------------------- -------------- - -- ------DATE -----------1-------------- ------------------- ---------•----------------------------------------------------- ' JJ��((��////��'��/��II ----------------------------------------------------------------------"---------------"-------•--- --------"----------------"----------'"---""_---V "----------"---------""-"--""-----"------"--""_--"---------'------"""-------- --_"-__-__----_"---____---__"-----------------___-.-----_.-- -_ _• Fina[ Inspection by: ............... ------------ - --- ------- Date JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.