70-602 - Laserfiche WebLink

Home Browse Search

FORTQFFICE_USE: ` u APPLICATION FOR SANITATION-PERMIT f =-------------------------------- ----------------- (Complete in Triplicate) AN�`C/ 'ermit No. ------- _--- __ TlllGir.+ ` " Date Issued --------- --- --- This Permit Expires T Year From Date Issued --- e_ r Application is hereby made to the San Joaquin Local Health District for .a permit to construct and install the work herein described. This application iissf/made in compliance with County Ordinancee No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC TION/T1/_ _`p-- :5Z----- -- �-N}/ [� /� S- -- f-'_ SUS TRACT �� - - Owner's Name -- / - - _ -a� :-__-- -- Phon --------------------. -------------=- ---------------- p -------------------------------- zs� P Address --�----------------- --- ----------- �Il��-------------------------------------- City d�- Contractor's Name _-- C,0 - _; --------------------- License ,�_ Phone t� F/ Phone "� � 4 Installation will serve: Residence Apartment House-❑ Commercial❑Trailer Court ❑ Motel ❑Other-------------------------------------------- Number of living units:---- Number of bedrooms -3------- Grinder ------------ Lot Size -_____________________ Water Supply: Public System and name ---------------------------------------------------------------------------------------------------....-----Private Character of soil to a depth of 3 feet: Sand i Silt❑ Clay .❑ Peat❑ SandLoam ❑ Clay Loam C] _ Hardpan p Adobe ❑ Fill Material ____________ If yes, pe__________________________- (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 seeps pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK l�1 [,4-' s S_ize___ a Capacity --- Type Material Compartments -----_- istance to nearest: Well ---- _r_______________ _____FoundationQ --_----------- Prop_ Line ____�,_-______:_____-_ LEACHING - pN LINE ( No, of Lines"___, ______________ Length of each line______�X�_______.___--__ Total LengthQ� Y 'D' Box ?r Type Filter Material .__.Depth Filter Material f ------- _______________________ r Distance to nearest:.Well ____ _____________ Foundation ___to__°____________ Property Line ----S------_____.__-- SEEPAGE PIT [ ] Depth ---------_---------- Diameter .................. Number ---------------------------- Rock Filled Yes ❑ No U Water Table Depth ---------------------------------------• -------Rock Size -------------------------------- t �. t Distance to nearest: Wel( ________________________________________Foundation -------------------- Prop. Line --------------------- REPAIR/ADDITION(Prev. Sanitation Permit#•-------•---------- -------------------------- Date -----------------------------------I GSeptic Tank (Specify Requirements) ---------------------------------------------------------------------------------------- -------------------- .--------------------------- Disposal Field (Specify Requirements)' ----------------------------------------------------- ------------------------------------------------------------------- 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 accordancewith-San-Joaquln 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - ------ - --- --- -:----- --------------------------------- Owner -- BY ------ - i -:------ -- ------------------------------- Title - (If other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------- ----- --------------------------------- --- J = = ---------. DATE ----BUILDING PERMIT ISSUED ---------------------------------------------------------•---------------------------------=- ------------DATE ------------- ----------------------------- ADDITIONAL COMMENTS - - ------------------------------------------------•------------------------------ ------ -------- - -/DISTRICT ------------------------------------------------------- --------------------- --- -- ---- -- '&(- _________________________________ _ _ ___ _ _ _ _Final inspection by: L -- -------- --- --------------- Date =� -- F SAN JOAQUIN LOCAL HEAL E. H. 9 1-'b8 Rev. 5M