73-390 - Laserfiche WebLink

Home Browse Search

---------------FOR- - --OFFICE- - -USE: APPLICATION FOR SANITATION PERMIT - -- - -- --- ---- •- Permit No. ____ _____�.._ 6 (Complete in Triplicate) - Date Issued ________________ �-0 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 . Vjz /-__- _ -_-�/- -=-----CENSUS TRACT __.-__-_______---_-.____ Owner's Name ------------- -- # , -----------------------------------------------------:----------------- j -------Phone ------------------------------------ Address --- ------------------ ----------- ---------- -------------- City -------------------------------------------------- Contractor's Name ___ �-srPi[�_ =A-- - ._..License v 1-9--- Phone --------------_-------------- Installation will serve: Residence partment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:----/------- Number of bedrooms __0------ Grinder ------------ Lot Size ______________-__-____--_--_.____-____.--- Water Supply: Public System and name -------------- ----------------------------•------------------•------------ ------------------• ---Private ❑ Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat E] Sandy Loam ❑ Clay Loam F-1 Hardpan ❑ 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.) O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK,[ ] Size-----------------------------------.------------ Liquid Depth ___________-_-----_____. Capacity -------------------- Type -------------------- Material--------------------- No. Compartments ...................... Distance to nearest: Well -_-______________________________Foundation ---------------------- Prop. Line ---.______-_._...._.__ LEACHING LINE [ ] 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 [ J Depth --- ---------------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well _______________________________________Foundation -------------------- Prop. Line -_____--_----------. REPAIR/ADDITION(Prev. Sanitation Permit#' ____________________________________________ Date ----------------------------------) Septic Tank (Specify Requirements) ---/- ---- -- -�- -/-- -------------- ------ - -- -- --- -- - - Re uire -__ ------- _ _------------- Disposal Field (Spe --_-__ ------------------------------- -------------------------------------------------------------- --- -------------------------------------•--- ---------------•-•- -------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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, 1 shall not employ any person in such manner as to become s iect to Workman's Compensation laws of California." r Signed - Owner By ------ - ------------------ ------------------------------------------------ Title ------------------------------------------ ---------------------------- (If other than owner) FOR E ARTMENT USE ONLY APPLICATION ACCEPTED BY ________________ - -------- ---- ----- ------- DATE __-_ _-__= - '� ----------- --------------------------------------------------------- BUILDINGPERMIT ISSUED ------ -------------------------------------------------------- ----------- ------------------------------DATE -------------•---------------------------- ADDITIONALCOMMENTS ----- ------------------------------------------- ------------------------------------------------------------------------------ ------------------ ----------- ----------------------------------------------------------------------------------------------------------------------------------- ------------ ---------------- ---------------------------------------- ------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------ ------ -- - ---- - - - - - - - - - - --- ------- --------------- -- --------- Final Inspection by: ----- -% ---------------------------------------------------------------Date -- � }----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M