70-898 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION' Plr MlT ��9�' ------ ----- ------------------------------------------------- �1 P rmit No:.. .- (Complete in Triplicate) �1 --=----------------------------------------------- This Permit Expires 1 Year Froin Date Issued ate Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein, described. This application is made in compliance with Count. r mane No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION --y_q y _ � �Pl�.C3 ------- --------------- ---------- TRACT --------- Owner's Name ------4��------ -------------------------------------------- ------------ - -- - - Phone Address .__ ----- -------------------------- City G d ------------------------ -----, Canfiractorq Name ----------------------------License # -/7 �i�-�--- Phone Installation will serve: ResidenceR Apartment House,❑ Commercial ❑Trailer Court .❑ Motel ❑Other -------------------------------------------- Number of living units:._---- Number of bedrooms __9-----Garbage Grinder/YO------ Lot Size _z� --------------- Water Supply: Public System and name --------------------------------•-------- -------------- ------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: SandJZ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ 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.] I�v NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] Depth --------------------------- Liquid PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size_____________________________T"-___.--------- -- Li q p � 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 --------------------•-----!------ --------- 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 ------------- :=---- I REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------.-------------------I Septic Tank (Specify Requirements) - ------------------------------------------------- ----------------------------------------:------- --------,<---------------------------- Disposal Field (Specify Requirements) , rte -----Q -------- _V -------------------------------------------- ------------------ ---------------------------------------------------------------------------- ---------------------------------------------------- -: ------------------------------------- ------------------------------ ------------------------------------------------------------- -------------------------------- ----------------------- ----- - - (Draw existing and required addition on reverse side) 1 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 shall not employ any person in such manner as to become subject to Workman's Compensation laws.of California." i Signed /If ----- ------ -------------------------------------------- --------- Owner BY ------- Title ------------ ----------------------------------------------------------- r t an owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- ` ------ -- - ------------------------------------------------------------- DATE -._1 "- --------------- BUILDINGPERMIT ISSUED --------- ---------------------------------------- ------------------------, --DATE ------------------------------------------- ADDITIONALCOMMENTS -------------------- - --------------------- ------------------------------------ --------------------------- --------------------------------------------------- -------------------------------------- -------- -------------------------- - - -- ------ ------- ---------------------------------------------------- x .. . . ------------- ---- Final Inspection by: ------------------ �-`- ------'�.`�--- --------------------------------------------------- --------------- Date _/ -'/U _ - - - --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M.