75-417 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ---------- APPLICATION FOR SANITATION PERMIT A10----- (Complete in Triplicate) Permit No: ......:...... ........ --------------------------------------------------------- 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/LO ATION _Y- CENSUS TRACT_ ` - -------- ------ - -- ------- Owner's Name =4._ ----- - -- Phone one -- --- - ----Address ----- ---------- Cit ----- --- - -- % Contractor's Name -------------- -------- ----�!_r !----------License #p�1.1='; f,�----- Phone Installation will serve: ResidencegApartment House❑ Commercial ❑Trailer Court Motel ❑Other Number of living units: .... __----- Number of bedrooms ____Garbage Grinder ________ Lot Size ------15�__ --- .__-__-_ 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 E] Adobe [:] Fill Material _._______ If yes,type-------- -------_---___------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed onlreverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is availGable within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size------- � �---------------------- Liquid Depth ... _.__. Capacify l :__ TYpe --- --1 Material_ ---_ No.' Compartments __ ............. O Distance to nearest: Well ------------ - __._ _ ___,�___r_-_____•-Foundati ��D_--_.___--_-;Prop. Line ...47,t......... LEACHINGLINE [ No. of Lines d l �YLength of ch line._____ _. ( _ Total Length ____________ 'D' Box ------Type Filter Material __� _ __ ______Depth Filter Material ----------- 7 _. _ . _ Distance to nearest: Well ------I------------- Foundation ___ ---------d Property Line / SEEPAGE PITDepth -- - - - __ Diameter ___ ___________ Number ___. _ -_ _ --_ _-__ Rock Filled Yes ❑ No i❑ [ l ------ Water Table Depth -------- -------Rock Size -------------------•---- { _ Distance to nearest; Well -.-- ,�_----._•Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# e --------- --- Date --------- Septic Tank (Specify Requirements) _---_--_..-_ ---------------------------- ---------------- -•------- . -----••---------- Disposal Field (Specify Requirements) ---------------------------•--------------------------------- ----------------- --------- ------ -- - -- (Draw existing and required addition on reverse side) 1 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 _10* BY ------------- ------ -- ------ - --- Of-1 --------- -- (1 other n owner) ------ =------------- -------- Title ----------- --------------------------------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ____ -- ___ ______ BUILDING PERMIT ISSUED ------ ---- -------------------- ----------------------------------..__. DATE ----------�---------�------------� ADDITIONAL COMMENT ------------------------ S --- DATE -------------------------------------------------------- ------------------------------- ----------------------------------------- ----------------------------------------- ------------- - -- ---------------------------------------------------------------------------------------- ------------- Final Inspection by: -- - Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M