72-1124 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: SQ'�� 715,T` APPLICATION FOR SANITATION PERMIT -------------------- - -d 3;J (Compl6te in Triplicate) Permit No. 7,_ �_._.___-_. _ 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/LOCATION -- C_<</�--' `- /-_--- ---------------------------------------------------CENSUS TRACT -------------------------- Name .... ,1G`el ��----- L� `fN-�---- -------------------------------------------------------------Phone Address ------- ------ ----- --- ---- -- --- ------- ------------ City ---------- Contractor's Name __�f�t4 G�� ------- ---------------- ---License # f 77IM&I----- Phone Installation will serve: Residence [X Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other --------------------------------- ---------- Number of living units:--- ------ Number of bedrooms _J------Garbage Grinder 1_14�--- Lot Size _`__ _____________________ Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private 19 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe j$(" Fill Material ----- If yes,type ____________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) .� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK:K Size_. ------------------------------------------ Liquid Depth t//--------.----------- Capacity --..__-__-Ca acit / L.-_ Type/09,^ Material No. Compartments fes................ Distance to nearest: Well ____L�7'_____________________•Foundation ___A�____.______ Prop. Line -----_________---. LEANo. of Lines ------------------ LEACHING LINE [� ------�----------- Length of each line-----`$�_-________-____ Total Length __��-_._______._ 'D' Box ------------ Type Filter Material _______________-___Depth Filter Material -------------------------------------------- Distance to nearest: Well _ice'__ ___________ Foundation ___d�_ -------------- Property Line ._,5'r............. SEEPAGE PIT bdf Depth L ------ Diameter 213-----__- Number -------- _____________ Rock Filled Yes No i❑ o ` �1 it Water Table Depth �� _____________________________________Rock Size __Ll._ _ ._-_---______ Distance to nearest: Well __/4'2__ _________________________Foundation -_ Prop.Prop. Line _4.................. REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ________---________-____-_________) Septic Tank (Specify Requirements) _ _____----___._ _________ ___________-- Disposal Field (Specify Requirements) --------------------- ---------------------------------------------- --------------- -------------- -------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- ------------- (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 Gr. - ---------------------------------------- (if o than owner) OR PEPA9fM_E_N_'y USE ONLY APPLICATION ACCEPTED B ------ --------------- -------------- DATE --- /_ ?Z-- ----------- - --- ---- BUILDING PERMIT ISSUED ---- -------------- - DATE ADDITIONAL COMMENTS --f! 27_-r---- � .------- - ------------------------------------------------ ------------------------------------------------ ------------------------------------------- ------------------------- ---------------------------------------------------------------------------------- ----------------------------- - - ------------------------------- ----- ---------------------------------------------------- ---- ------------------ -- - - -- - - - ---------- FinalInspection by --------- <- -- --- -- - - ------------------------------------------------------------------------------- Date ,� ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M