68-484 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: � " r APPLICATION FOOSANITATION PERMIT -------- --------L==-10------Ak ZJ---------- 'id'#, (Complete in Triplicate) Permit No. ` ______---------------- This Permit Expires-1 Year From Date Issued Dote Issued - " Application is hereby made to the San J aqu n 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: i f G� J JOB ADDRESS/LOCA N .--- / ---_-_-:.,.T -- ----------- - --------CENSUS TRACT ------------ ........... p U 1 Owner's Name ._. __ _____ _�___ Mme= __ �- - `- -', ' - --Phone _-7--/4-m------------------- Address _ ,�/ � Contractor's Name - - _ ------------------- -L ci ense # Phone Installation will serve: Residence partment House❑ Commercial []Trailer Court C] ��yy Motel ❑ Other -------------------------------------------- Number of living units:.-d1_ Number of be roo s. ____Garbage Grind _________t_ Lot Size //.-L-/�__. _ _____•__- Water Supply: Public System and name _______ : __�_ .1. _-____��r e•.±____.______..______Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt,❑ Clay C] Peat❑ Sandy Loam -❑ Clay Loam i❑ 1 Hardpan❑ Adobe' Fill Material ------------ If yes,type -----------__------- ------- E (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be,placed on reverse side.) p i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �v PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth --------------------------- Capacity - j Capacity _____ Type ____________________ Material__________________ ___ No. Compartments Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------------.---_- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line------------------------_--- Total-Length ----------- ---------------- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------.--------------------... j Distance to nearest: Well ________________________ Foundation ------------------------ Property Line ______:__.._. SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number -------------- ------- ----- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size ------------------------•------- Distance to nearest: Well _______________________________________Foundation -------------------- Prop. Line ____ ................ REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- Date ---------------------------------- f Septic Tank (Specify Requirements) _______________ i -- Disposal Field (Specify Requirements) _ I Q /------------------------------- ----------------------------------- ---- -------------- - ------ -- ------------------ - --- ----- ----------------------------------------------------------- as --------- ------ ------------------------------- - -- {Draw existing and r quire additi non 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. 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 shallnot-employ any-person in such manner as to become subject to Workman's Compensation laws of California." Signed ----------- ------------------------ ------------------- - Owner ------------ ---------------- BY ----------------------------------------------------------------------------------------•-•---------- Title ---------------- - - (If other than owner) w F EPARTMEN USE ONLY [ APPLICATION ACCEPTED BY ------- ---- -- 4` ---------------------- ---------- DATE ------J'7--j�=��---- ------ BUILDING PERMIT ISSUED -------- --------------------- ` -------------DATE ---------------------------- -------------- ADDITIONALCOM WTS ------ =----- ----- -•- ------------------------------------------------------------------------------------------------------- =l°= `- r-7----------=--- �-.-- ---- - i-------------,�--------------------------------------- ----------------------------- ------- - ----- - --------------- --- ----------------------------- ------------------ •�. , Final Inspection by: ------------------------------------------ Date __6n -G-^�Y------------------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M