72-265 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ------------------------X Permit No. (Complete in Triplicate) --------- -- 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 ounty Ordina a No. 549 and existing Rules and Regulations: r JOB ADDRESS LOCATI 1 � 4 Q ----------------------- Owner's t ------------------------CENSUS TRACT __S------- / J- - -------- + Owner's Nameh' -------------- ------- Phone Addresses - ----- ---- -`�J - City R, = Contractor's Name Q- ------r-------- - - - ---- ----- ---- - - ---.License # -1 _`.?� ' Phone -------- ---------- Installation will serve: Resident YApartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------a-►-------------------------------------- Number of living units:____ _____ Number of bedrooms _�-----Garbage Grinder ------------ Lot Size -0- TOL..--.""------•- 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 0( Adobe ❑ 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 [ ] SEPT C TANK Size__ _ "" `_ - -X` ------- - Liquid Depth _V------------ O Capacity _� _ __ _ Typ _ __ �_____ Material._�/I�-�----- Na Compartments .�.............. Distance to ne st: Well ___________ _ _____________Foundation ------- _p ____ Prop. Line ...................... LEACHING LINE [t*j/ No: of Cines---_ =________'_ Length of each line-___ _ _ '"- -------- Total Length ,__._�. �� • tip 'D' Box _' Type Filter Material _----Z--R----Depth Filter .Material -----T_1________._:-"------------------- Distance to nearest: Well ------_4IG:_.________ Foundation ______1_C__'_______ Property Line ....... . ............. SEEPAGE PIT [tf4, Depth __-_ �_--__ Diameter Number -------- -------- Rock Filled Yes [t No 0 Water Table Depth ------- _ 5--------------------------------Rock Size --- ---- . R � A Distance to nearest: Well --------------Vtt___...____.___....Foundation '___ -P_..---•---- Prop. Line ........ REPAIR/ADDITION(Prev'., Sanitation Permit# -------------------------------------------- Date ____-__"-_--__.____-----_---------) Septic Tank (Specify Requirements) -------------------------- -_--------------_--------------- DisposalField (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: "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 man's Compensation laws of California." Signed--------- ---- - - - Owner --- - -- ------------------ C1Title / ---------------------------------------- By ----------- ---------------- --,e '` -- - 9` '* (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- -------------------------------------------------------------_ DATE ._s "-f------ BUILDBUILDING ING PERMIT ISSUED ------------------------------------------------------------------------------------------- -------DATE ------------- ----------------------------- ADDITIONALCOMMENTS --------------------------------------------------------------------------------------------------------------"---------------------------------------- ------- --------------------------------------------------------------- ------------------------------------------------ ------------------------------ ------------------------------------------------------- - - ------------- -------- --------------------------------------- ---------------- ---------- - -- FinalInspection by: -------- -- -- -�- - - --------- ---- ------------------------------------------------------"--------------------.Date - ------------- --Z-- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M