71-480 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r' APPLICATION FOR SANITATION PERMIT ------------ Permit No. -7J:7�00___.. ' (Complete in Triplicate) ---____--------------- This Permit Expires 1 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIQN .---------------------- -- A - Al N S TRACT -------------------------- Owner's Name`�l -------------:---------------=-• -------------- --Phone ------- ---------------------------- p ------------------- City ,----------------------- --------••- ----- {yAddress .� Contractor's Name -- -- - -- � � ---------------------------------License # _ Phone0Wd_1�2d/� Installation will serve: Residence Apartment House'E] Commercial ❑Trailer Court i❑ Motel ❑Other ---------------------------------------- Number of living units:__-_f___-- Number of bedrooms ___.Garbage Grinder*v___ Lot Size phs.- '_____________ Water Supply: Public System and name ---------------------- --------------------------------------- -------------•----------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt F] m// ''Clay ❑ Peat❑ Sandy Loam ❑ Clay Loa Hardpan ❑ Adobe ❑ Fill Material ____________ If yes, type ---------------------------- i (Plot plan, showing size of lot, location of system in relation'Nto 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,) ----------------------- Li uid De th _�_ PACKAGE TREATMENT { ] SEPTIC TANK Size_ _ _ q p Capacity _ - ___ Type� __ Material&eoo e_ No. Compartments -�............ Distance to nearest. We _ Foundation Prop. Line _ LEACHING LINE ( No. of Lines __--;_1 ________________ Length ofgach line _' �____-_.._---- Total Lenges 4_21P--------------- D' Box _ _: Type Filter Mafier`IAepth Filte jMaterial�, Distan to nearest; Well --- _________ Foundation A10--------------- Property Line _40---__-_ - SEEPAGE PIT Depth #7 - --- Diameter _.. l-- Number _1112-___________ ______ Rock Filled Yes,je Water Table Depth -------/tl- No 0 ------------ -----------•._..Rock Size/ __ A,"-- ��' " ; Distance to nearest: Well -----,1;, 19-------------------Foundation X Prop. Line 1414-____ REPAIR/ADDITION(Prev. Sonitationi Permit# -------- ----------------------------------- Date __________________________________) SepticTank (Specify Requirements)------------------------------- -------------------------------------------------------------------- ------ --------------------------- DisposalField (Specify Requirements)-.-'---- -------------------•--- -------------------------------------------------------------------------------------•--------------- ------------------ ----------------------- ---- - ----------- --- ------ ---- -------------------------- ---------------------------- r q f I (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 By ------------- - --(If ot- - ---h-e an owne-- ne r) ------------------------ Title --------- , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED i3Y ------------------------ DATE --c�r--�U---- ------ --- f BUILDINGPERMIT ISSUED -----------------------------------------------------------------------------=----------•------ -------DATE --------------------------------- ADDITIONAL COMMENTS ------------------------------------- ------------ ---------------------------------------------------------------------- - 1}-�-----7�V/; S- -7,/------------- -------------------------------------------------------------------------- ---------------------------------_Z ,_1------------------- ------------------------ ------ -- ------- ------------------------------------ - ,,�--------- 1____7 Final Inspection by: T�1 (� �,/ Date --- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M