71-696 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / r (Complete in Triplicate) Permit No, __________________ This Permit Expires 1 Year From Date Issued Date Issued 6666__.'__--------- 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/LOCATION . �� lC 1-s -N�✓ ----- --------------------------------------------- -------------CEN SUS TRACT ----s -------------- Owner's Namel�LI��:CJ��}//�1 __--1=1�.5©---------------------------- _- ----------------Phone --------------------------------- Address ---- ---------------------FIN4�`--•---l-?-Q----------------------------------------------. city ------lle4cy------------------•-------------------------------- Contractor's Name ------------ --Q 1 .-----------------------------------------------------.License # ------. -------------- Phone ----------------------------- Installation will serve: Residence ❑ Apartment House❑ Commercial ;❑Trailer Court Motel-VOther --_'ll __T'0LT'y------------------- Number of living units:_____ Number of bedrooms _=--------Garbage Gr n'd.-rV----_.______ Lot Size ____ _ __-------------------------- Water ________________ ______Water Supply: Public System and name ___________________________ ,o\ -------------------- -----------------• Private. -- Character of soil to a depth of 3 feet: Sand's Silt❑ Clay ❑ Peat❑ Sandy Loam .0 Clay Loam ❑ 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 public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK:[-]` Size--------194 ______-_____.__,_ Liquid Depth Capacity -------- Type ________ °Material-. GE'`" No. Compartments Distance to nearest: Well ______ _U0_O!______________ dations_; ___ _______-__ Prop. Line ._ �� ------ `` -- LEACHING LINE [ ] No. of Lines __.______!__------------ Length of each line______----7_0----------- Total Length ____!0-(::?_-------6666___' ' 'D' Box ------------ Type Filter Materials J __-Depth FF�ilt"�e�'r Material ------- -------- ----------------- + .amu__..-- Property Line _�________~�- ---- 3 •. Distance to nearest: Wel! __.��_.______ Foundation ___ ------ � k SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number --------4_1'_-r%Pa_.------ Rock Filled Yes ❑ No i❑ ' F Water Table Depth ------------------------------------------------Rock Size -----------------------•----•--- Distance to nearest: Well ----------_-----------------------------Foundation ____________________ Prop. Line ---------............ 1 REPAIR/ADDITION{Prev. Sanitation Permit# _______________6666_______ _____________ Date __________________.._.________ -- SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ----------------------------,..----------------•---------- F Disposal Field (Specify Requirements) -----------•--•------------------------•----------------------------------------------------------------------------- ---•----------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---•----- --------------------------------------------- - -----'-6666-- -- -- -----=---------------------------------6666-- - --- - -- - - -6666-- '6666---666666 66---'-----------6666-- (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 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 to Workman's Compensation laws of California." Signed .... ---------------- ------------- Owner ---------------------------------------------6666-- -- BY ---- ... ------- ---------------- Title 6666- ------------- ----'-6666-- - -'-------------'6666--6666-- (If other than owner) FOR DEPARTMEN USE LY APPLICATION ACCEPTED BY ------------------------------ DATE --- � � Z ------------- BUILDING PERMIT ISSUED ------------------------------------- -------------- ------------------- ------ ------- --------------DATE ADDITIONALCOMMENTS ------- --------------------------- ------------ ----------------•------ -------------------------------------- -------------- --------------------------- ------------- --------------------------------------------------------------------------------------------------------------- ---- --------- ------------------------------•------------------------- --- - - - - - 6666-- - --- - --- 6666 -- - 6666 - Final Inspection b -------Date 6666-- 6666 '�' _ P Y ---- ------ ------- SAN JOAQUIN LOCAL HEALTH STRICT E. H. 9 1-'68 Rev. 5A t4