71-161 - Laserfiche WebLink

Home Browse Search

R OFFICE USE. jAPPLICATION FOR SANITATION PERMIT -- - - ----��r-- -. �X��'G� (Complete in Triplicate) Permit No. Date Issued ._ ---- - ------ ------- 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: JOB ADDRESS/LOCATION 7[ � _ ----7e'r CENSUS CE --.-. TRACT Owner's Name ------ ----------- - - - -- -.---- - one _ _--� Address -� e�- Ph =� -- ------------ City .._. �. -C.� Contractor's Name - - -.� /;_� --._ 3 �c} ------ ----------- --License # .-Q-_/�.�'.-- Phone Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court :❑ Motel/[-] Other - -------------- -- --- Number of living units:--_- Number of bedrooms _2-- Grinder _____ --- Lot Size /;Pln.... --.1 .:5_------------ Water - ----_- Water Supply: Public System and name -.-_oat— -------------- - --------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'o Silt❑ Cloy ❑ PeatX Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe F] Fill Material - If yes, type -------------- (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 --.---------.---------- ------------ Capacity -- ------ ------ Type ----------- --- Material- --------- - ----- No. Compartments ---------------•------s Distance to nearest: Well ------------------Foundation -- -------- Prop. Line ----------------------0 LEACHING LINENo. of Lines [ ] --- ----- ----------- Length of each line----. ---0. - -.. Total Length 'D' Box - Type Filter Material .-_----___-----Depth Filter Materia(SEE Distance to nearest: Well .__----------------. --_ -- _- Foundation .-----._._-------------- Property Line ------------------------ PAGE PIT [ j Depth . —�� ----.- Diameter --�-------�--_-- Number - ---..------------------- Rock Filled Yes ❑ Na ;❑7 Water Table Depth ------- ----- ----- ----------Rock Size ---- Distance to nearest: Well ----------------------------------------Foundation ---.--------------- Prop. Line -------------------- AIR ADDITION(Prev. Sanitation Permit# ----- -- .--------------- -- Date -----.--------------.----_--_-- Septic Tank (Specify Requirements) --_. ------------ --- -----y___ -------- Disposal Fuld ( cify Requirements) - ------ -------- ---- ------ ----- ----------- 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 become iect to Workman's ompensation laws of California." Signed -- � --------- ----- Owner BY . `"-the n o' - -- --------- ------- -- -Title f (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _f�'.i __-__-__xw DATE - 7� BUILDING PERMIT ISSUED . -- -- - ---- - --- ................ - ---- - --- DATE ADDITIONAL COMMENTS -- - - - -�---- - - - - - -- -- - - --- -- -------- ----- - ------- ------ ---------- - ---------I-------- ----------------- Final Inspection b , - --------- -- -- - _- .Date -�==-j LL--- f- SAN JOAQUIN LOCAL HEALTH DISTRICT '1 E. H. 9 1-'68 Rev. 5M