69-138 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) sm- ftFbmit No. - -- --- -------- --------------- ---- ------------ This Permit Expires i Year From Date Issued Date Issued _,----- Application --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 _3.C.QS------. J------_ z -------- ------------ -----CENSUS TRACT -------------------------- Owner's Name ------ iG.� ----------------------------------- - --- Phone ------ ----------------------------- Address -r - - �`�' - ---- -- ------- - -- -------------- ---- City - --- '-�`-'�'�' ""`�'`�__-----�------------ Contractor's Name - --- z �._.License #IfeP3y�. _ Phone ------------------------------ Installation --._______________________ _Installation will serve: Residence gApartment House❑ Commercial []Trailer Court ;❑ Motel ❑ Other - ---------------- Number of living units:______- ..._ Number of bedrooms �_-.--Garbage Grinder ------------ Lot Size __` _ - --------------------- Water Supply: Public System and name -------- ----------------------------------- --------------------- --------------------------------- -------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [Clay Loam ❑ Hardpan Adobe Fill Material ------------ if yes, t (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----------------------------__ _______ _________ Liquid Depth __..___._..___._._________ 0 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 f=ilter Material --------_----------------------------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ____--_____-__-_._._.-_- SEEPAGE PIT [ J Depth ------ Diameter -------------- Number ---------------------------- Rock Filled Yes ❑ No CO] Water Table Depth ------------- ----------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation ...----------------. Prop. Line -----------.---_.__--. REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date --------------------------.-- --) Septic Tank (Specify Requirements) ------------- Lo r3----I-ct.�---------------- ------------------------------------------------------------------ -------- DisposalField (Specify Requirements) -------------------------------------------- ------------------------------------------------------------------------ --------------- - -- 20 > J 4 , 1 - �`-�- Q-t-- - -- `(-- ------------------- ------ ---------- --- --------------------------- raw 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 becom u 'ect to Workman's Compensation laws of California." Signed ------- - ------------------ --- Owner pp�� ,� BY ------------ --- ------------ - Title <.`-"'" f` 1�' (if other than owner) FOR DEPARTMENT USE ONLY D APPLICATION ACCEPTED BY DATE --'-1�-:�/-_.._._ - - -- -- ------------------------------------- ---- BUILDING PERMIT ISSUED ___________ ___ DATE ..............--------- ----------------- - -- ---- -- ---------------- ADDITIONAL COMMENTS /,JyJ d --------------------- ------------------------------------------- -- -------------------------------------------------- ----------------------------- --------------------------------------------------------------- _- ....--------- _._. ------------- -------- Final Inspection by: :__ Date µ --� _-------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M