71-320 - Laserfiche WebLink

Home Browse Search

R OFFICE USE: �. APPLICATION FOR SANITATION PERMIT ....... �j Permit No: (Comple4 in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued _. *.7!. 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 . - 1 ! .'. -of-- -- ----- ----- ---- CENSUS TRA, . . ...._... Owner's Name 1.� �e. ... .. . ............. P ne '.?74Q-- Address --------------------------- �l� --. - ' City ........................... Contractor's Name----- --- - •---- --------------- -- --- -- ---------------------........License # ----- - - Phone ....... �rs Installation will serve: Residence O(Apartment House❑ Commercial ❑Trailer Court Motel ❑Other----- _------------_--- Number - --- -- -•- Number of living units ----- --. Number of bedrooms. :,.I_ G-orbage-Grinder -_---_..---_ Lot Size '�d� ................... Water Supply: Public System and name ...................... -- -------- - --- ........................................... ..........Private Character of soil to a;depth,of 3 feet: Sand'0 Silt 0 Clay ❑ Peat❑ Sandy Loam 0 " Clay LOOM,[] Hardpan ❑ Adobe Fill Material ------------ If yes,type--------------_--------- (Plot ___________ __________(Plot plan, showing size of lot, location of system in relation to wells, buildings, ,etc. must be placed on reverse side.) "5 NEW INSTALLATIOFI, (No septic tank or, seepage pit permitted if public sewer is available within 200 feet,) [ ] � Liquid Depth ................ PACKAGE TREATMENT SLPTIC�TAN'K�[ ] Side- -------- ------------ - ------------------- Cgpauty - `- --- ------ Type Material._-- _--_------------ Na Compartments Distance, to nearest: Well ------------ ---- - ---- -,..-.Foundation ....-_.-----------=--- Prop. Line .......-................ LEACHING LINE ["] No. `of,,Lines ________________________ Length of each linea------------_-------- Total Length ----------- 'D' Box __------__-. Type Filter Material :. - ----- Depth Filter Material ------.......... .. .. ......:......:... Distance to nearest: Well _________ ____________ Foundation ------------------------ Property Line ........................ Y SEEPAGE PIT [ ] Depth -------------------- Diameter ................ Number -: ____________ _. _______Rock,,Filled Yes ❑ No .0 Water Table Depth .........---...........= ---- ................Rock Size ------- -------------- c----- f , Distance to nearest: Well ------------------------------------...Foundation ._....-------------- Prop. Line .._. --_._-_.-•_- REPAIR/ADDITION(Prev. Sanitation-Permit# -------- ------------------- -----=- -= Date ---------------------------------- Septic -..--:-------.-_.-- ----:-------Septic Tank (Specify Requirements) ----------------- Cjr . ----•- Disposal Field (Specify Requirements) y .......... ----- - --- ------ -------- --------- - - ---• i- ----- -- --------------------------- -------- ------------------------------------------ -,------------------------------------ -------------------------------------------------------- (Draw ------ ---- - ----- -------------- (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 Son 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: _ "1 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 -- ---- --- ------------------------------`-- •-- . -•---------- Title ---- (if -- ` --------------- By (if other than ed oa FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ...-................................ ----- ---=-. DATE -.--•-_---- BUILDING PERMIT ISSUED ----------------------------- ---------------------------------------__------_- -------- ----;,_:._DATf ------- •-• ---------_-_- ADDITIONAL COMMENTS- .. t*s Final Inspection by: _.. _. - s s ......•----•--- ......4 ...----..Date `- . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M'