68-794 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ` APPLICATION FOR SANITATION PERMIT_ 7791 I Permit No: _. ___ _- ---- (Complete in Triplicate) --------------------------- Date Issued Applicatil----•- ----------- ---- _- This Permit Expires 1 Year From Date Issued ---------------- on 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: I - - ------------------ ---------------------------------CENSUS TRACT ------ JOB ADDRESS/LOCATION .___ - --- ��[[ Phone •---------------- e---------------------------------Owner's Name Citf---•--.------ Address L _.d'.�'_- -----=- - p ' Contractor's Name -- � =---- / ----------------------------------------License # _ _ _ PhoneO Installation will serve, Residence ❑Apartment House❑ Commercial Orailer Court .0 Motel ❑Other -------------------------------------------- Number.lof living units:------------ Number of bedrooms ------------Garbage Grinder ------------ Lot Size ------------------ ------•- ---- Peat Sand Loam ----•------------------Private X Water Sj�pply: Public System and name ------------------ ---- ---------•---------------------•----------------- -------------------------------------- of soil to a depth of 3 feet: SandX Silt Clay ❑ ❑ Y ❑ Clay Loom El Hardpan--M -.,Adobe'❑. -Fill.Material =------------If yps,7vpe.----_--- (Plot plan, showing size of.lot, location of system in relation to wells, buildings, etc. must be` placed on reverse side.) NEWINSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) W ,- Y PACKAGE TREATMENT [ I SEPTIC TANK![ ] Size- {` -------------- Liquid Depth - • 4;:VMaterial ew-9 04% No. Compartments --_- f Capacity d--� a Type r �� Distance to nearest: Well ----------6-P-----------------Foundation ---------------------- Prop. Line -_C:S-i _---•---- � Total Len No. of Lines ----Z-------------- Length of each line ----'y�� gth ---•--------- tJG LINE [ ] LEACH! ---------•---•------ 'D' Box ----/_------ Type Filter Material __JQ0�---Depth Filter Material ______/.?-------• Pro er Line ------------------------ Distance to nearest; Well ------------------------ Foundation _______---------------- Property s SEEPAGE PIT ( 7 Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No C] Water Table Depth - ------------------------------------- - -------Rock Size -------------------------------- - Distance to nearest: Wel! ---------------------------------------------------Foundation ---------------•---- Prop. Line -.----------_------- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- -- Date --------------------------- ------ Se ti ---------- c Tank (Specify Requirements} ------ --------- - ------- --------- ------------ ------------ ----------------------------------------•-- ,,.----- Di pIlsal Field {Specify Requirements) ---------- ----------------------------------------------- --------- ------------------------- �N-------------------- _ .� - --- -------- ----- ------ ;-----------_—-� �"— (Draw existing and required addifibri'on`reverse sicle)""'�` I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County'I Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Wealth 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 b'scome subject to Workman's Compensation laws of California." Signed ----------- Owner ------------------ -------------------- -- --------------- --------------- --- Title ---------------- --- ------------------------------------- -- - -- -- --- ----- -------------- h (if other than own CFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY c¢gam.-. ----•--- DATE BUILDING PERMIT ISSUED -------------------- ------------------------------------------ DATE -----------•---------------------------- ADDITIONAL COMMENTS ----- -------- - - - ---------------- • ----------- ---.; - - -------- -------------- __ 1--- - ----------- - ---- ------ -- _ -_ .------- --- -------- ----------------------- ------------------- ---------- _ Final I'ns ection b c=��- Date p Y: -- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M