69-363 - Laserfiche WebLink

Home Browse Search

i FOR•o FILE USE: I - APPLICATION FOR SANITATION PERMIT ------- - ----- ---- - ----------- -�--r Permit No: .------------- (Complete in Triplicate) ------------------=- c/ ----------------------------------------------- ._- This Permit Expires 1 Year From Date Issued Date Issuedw�-' 1 Application is hereby madellto the San Joaquin Local Health District for a permit to construct and install the work herein - described. This application is made in compliance th County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC I N3 - -- `r-- - Q--------------- CENSUS TRACT ----------------------_._ u Owner's Name --------------------------- = Phone - ---------------------------------- Address ---------as I� ......- .tom City ------- �..�-------- c Contractor's Name -_ ---------------- 0A__ ._(j4�___ - _ __ _ _ _.License # --�� --- Phone ______._____________________ Installation will serve: Residence partment House❑ Commercial ❑Trailer Court ❑ i a Motel ❑Other ------------ --- - - - =_=-------- 4 Number of living units:_________ Number of bedrooms -7 Grinder -_--_ ----- Lot Size ______________________________________ Water Supply: Public SystemIand name - --------------------•-------------------------------------- ------- - ------------------ ------Private t Character of soil to a depth of 3 feet: Sand'VA t[ Clay E] Peat E] Sandy Loam E] Clay Loam:❑ Hardpandobe '❑ Fill Material ----------- If'yes,type --------------------------- (Plot plan, showing size ofj 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 ( ] I SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth --------------------------- L-4 Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ------ --------------- Distance to nearest: Well ------------------------------------Foundation _-.------------------- Prop. Line ------------- ..------ LEACHING LINE [ ] Noll of Lines ------------------------ Length of each line---------------------------- Total,Length ---------------------------- D JBox _________-___-_______-___.D'JBox ------------ Type Filter Material --------------------Depth Filter Material -- ----------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property, Line -------------------- SEEPAGE PIT L l Depth -------------------- Diameter --------------- Number ---------rte'---_,.-,- Rock Filled Yes<E], No 0 + Water Table Depth -------------------------------- Distance .� p ------------ -- --- ---------------':-:---Rock Size -------------------------•--• -- �' E Distance to nearest:.Well �r-------------------------------foundation -- _.,:.-: --.___Prop.Line ---------------------- � II! T - roi REPAIR/ADDITION(Prev. Sanitation Permit# -------- -------------------'- — -------- Date�- =_ --------------------I. f Septic Tank (Specify Requirements) ___-:.____ --------- ` & `i --'"' M Di 'Field (Specify Rte uirementsl _- ----- --- -- ------------ ®�- --f - - ---- " ----- ---- p Ip Y q 1 �r - ----- ---- - ----- -- ----- _. [ aw ex ng and uired addition on reverse side) I h f eby 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 licen- sed agents signature certifies the following: I "I certify that in the performance of thework for which this permit is issued, 1 shall not employ any person in such manner as to beco bject to Workman's Compensation laws of California." Signed --- -- -- - ----- Owner BY ip - -------- Title ---- - ./ACL d�--------------- ------- -- ---- ---------------- - (If other than owner) I� FOR DEPAitTMENT USE.ONLY' APPLICATION ACCEPTED BY, , - ------------------------------------------ ------ DATE t� ��/- ................... ! BUILDING PERMIT ISSUED -ir------------------------------------------------ --------------------------- --- ---DATE ------------------------------- -- ADDITIONAL ---------------------------- -- ADDITIONAL COMMENTS --- ------------- -- '--------- --- -------- ' ---------------------------------- ------------------ -------------- --- -------------------------- -------------------------------------------------------------------- -----------------I------------------------------------------------------------------ III ---------------------------------- ------ -------------- ------------------------------------'-"---=-----------------------=-------------- ------------------ 'l ----------- - -------------------- 1r --=- -- --- - Final Inspection by: --- - ] -------- - '----------Date ---- ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M .