70-811 - Laserfiche WebLink

Home Browse Search

FOR OFFICE: USE: v, APPLICATION FOR SANITATION PERMIT "-- - --- It _ ' e'..�� j`1�____ (Complete in Triplicate) Permit No.12�__Y' --------- 7o l----- ------ A - f -.. -- - Date Issued/ .' .._ -- ------------i.;. _________ -------------- This Permit Expires 1 Year From 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: . 7Z_ JOB ADDRESS/LOCATION - >-. -/ -- ---- ..._� ,e ------------------CENSUS TRACT .......................... Owner's Name -C-------- --. --Phone Address . -- . .. - tf s'�Z� -------------------- ------ --- ----------------------- City --- --- --- ---- --------...------------------------------------------- Contractor's Name - ----------- License # ----- ------------------ Phone Installation will serve: Residence XAlf artment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other--- ----------------------------------------- Number - --- --------------- - - � Lot Size .�� ------------ -- Number of living units: -.f-.--- Number of bedrooms �---_Garbage Grinder -_ �l -'- ' ._ �....__-__-..-._._ Water Supply: Public System and name - r? .. �%r y(�-_ f Pp Y� Y (�+ ��ff-- ----�-f-'6-.f ..t o'.-�-��_�----------------------------......... ...._.Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material . ... If yes, type ---------------------- .---- ff * [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] W NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [ ] SEPTIC TAN 'k- K Size---..------------------------- --------- Liquid Depth -----------_.............. Capacity - - - - . Type -------- Material--------- --------- -- No. Compartments _.------------------- Distance to nearest: Well ------------------------------------Foundation --- -- -------- --. Prop. Line ---------------------- LEACHING LINE [ I 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 ❑ Water Table Depth ----------------- -- --- --- - ----------- -----Rock Size ----- -------- - --------.. -- Distance to nearest: Well ----------------------------------------Foundation - ------------------ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ________ ________ ---------------- _______ Date ----------------------------------) Septic Tank (Specify Requirements) - --- --- --- --------------- -- ------------ .. -- ----- -------------- -------------------- -_ ---- Disposal Field (Specify Requirements) ------_ - ' srff 17 ------------- - -- ---------------- ------ -- ----- ----------- -------- - ----- - ------------------------ -- -- -- .--- --------------- --- - .. ....... (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 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 --- -------------- ------- BY -- -------- --- ---•-------- '- ,="` -*--------------- -- ------ Title = (If other'. an owner) FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BYi' `--A, ____ �' - m - DATE _/C� ..`.>.. ~ sr7 BUILDING PERMIT ISSUED - --- DAT} ADDITIONAL COMMENTS - -------- ---- -- --- - - ---- -- - --- -- -- - ------------ ---------- Final Inspection by: --- YL fr Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'48 Rev. 5M