72-229 - Laserfiche WebLink

Home Browse Search

•..--�— - l y�Ate, FO`R OFFICE USE: ' f APPLICATION FOR SANITATION PERMIT -------------------- ---------------- Permit No,�_�_"_2-_ (Complete in Triplicate) ---------=----------------------------------------------- ,�._ � Date Issued-----------------------------------------_-_----------- This.Permit Expires ! Year Frorn^ldbte Issuedl," Application is hereby made to the S n Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in com liance v ith County 0 climance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .__:?-YOU'' � ��-- CENSUS TRACT ------------------------- Owner's Name ?% f --- ------- ---------------------------- Phone o---`----� Address L J --------- City c1� Contractor's-Name ----------- e � __e-------License # ---- Phone ----- Ration will seraInsta Residence ❑Apartment House❑ Commercial ❑Trailer Court l❑ + .~ Motel ❑ Other ----- ---- ---- - - - --- - - - - - - -------------- Number of living units:------------ Number of bedrooms ------------Garbage Grinder ------------ Lot Size _---------------_----- Water Supply: Public System and name ------------------------ -----------------------------------------_--------------------------------------------Private E Character of soil to a depth-of.3 feet: Sand❑ Silt❑, Clay ❑ Peat❑ Sandy Loam Clay Loam.[] } Hardpan ❑ 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 rev`ersetside:)-- ' NEWxINSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] \/ PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size---------------- ---___------------------------- Liquid Depth _____-____--_.__k_�-=--;-- 1 Capacity -------------------- Type -=---------- ----------------- No. Compartments -------------......... s� Distance to nearest: Well ___- _____-----------------_____Foundation ---------------------- Prop. Line ----------- ,__________ LEACHING LINE ( ] No. of Lines ----------- Length of each dine_____ _--•_______________- Total Length -----------.___-. -________ 'D' Box ------------ Type-Filter Material _---'--------Depth Filter Material --------------------•---------•-` ----=-•-- — Distance to nearest: Well -----------------\_ Foundation __._-_�;"`'-------_ Property Line -------------'----- SEEPAGE PIT [ ] Depth -------------------- Diameter _---------- -_- Number -----------------------._i_2.Rock Filled Yes•,[j No C] Rock Size .- ---------- -#, .,�.�Water Table„Depth ---------------------------------------- --•- ' } Distance to nearest: Well----- --------- --- :----------Fou ndation-_- __._ --�,P,rop. Line ----------• ---------- 4 REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _____-__________-_--_,-___.___ --=-----•----------- --- ------ --- „...� --------------- Septic Tank (Specify Requirements) __________ _ Disposal Field (Specify Requirements) -------- ----------------- --' '` w "". N 1 f , ------------------ - -------------------------------- p ___- --------------------------- _k-_____-___-�_-_---___ ------------------------------_ -__ ,\-______________,___----________-_--_____-____-___ ------------ (Draw (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 1 County Ordinances, State Laws, andlRules 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 to Workman's Compensation laws of California." Signed _ �-_. - �. _.�.-�,.- ' ~ — Owner, --- ------ ---------------------------- Title _.-_ = ----------------- ----- (If other n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY "- -------------- -------------------------------------------------- DATE __ "+_ _'_ -- -- BUILDINGPERMIT ISSUED ------------------------ ------------------------------------------------- ----------------=--------------DATE ------------- - ---------_----------------- ADDITIONAC'COMMENTS - _ _ ._ _ - _ - --. ____________________________________________________________________________________y__:_`'--___---____-__________---__-____-___-__-____________-_-___________-_-_-________----____-___________---_.____ ____________ _ _ _1 --------------------- ---- ----Final Inspection Date SAN JOAQUIN LOCAL HEALTH DISTRICT F. H. 9 1-'68 Rev. 5M