68-994 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- Permit No. ------ -------- (Complete in Triplicate) - -------- --- This Permit Expires 1 Year From Date Issued Date Issued ��-`� ----- -- -------- --- - Application is hereb made to.the San Joaquin Local Health District for a permit to construct and install the work herein des cri a i atio i i m anteiith County Ordinance 5s4 No. 549 and existing Rules and Regulations: C7 LO JOB AD RESS/LOCAT ON . -� -'- � ---- CENSUS TRACT --- - Owner' Name -- 1//1 i�_1.� ✓c 'P - Phone ®® - --------------- Address 7-� - -"- ----"------------- City _ _LQ c�IQ ----------- A / /�/f-------------------------------------License# 7 C1-_ Phone c ., Contractor's Name _ _1:1----------- _ __ _ Installation 'will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other.------------- ----------------------------- i Number of living units:---- .____ Number of bedrooms .____Garbage Grinder O--- Lot Size __/VaA _� ___-------_ Water Supply: Public System andname............. ---•-----•----------....----------------------.. ---------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam w - Hardpan ❑ _. Adobe'❑ Fill Material _ _---------..If yes.,.,type_ _____ ---------- (Plot ,_______(PIot 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 f ] Size--------------------- _________________________ Liquid Depth ---- ____--_________ VJ Capacity _/ _C� Type Mated No. Compartments -- O Distance to nearest: Well :__c1�_________ ______ ______Foundation _�, ____________ Prop. Line __ ____ __________ LEACHING LINE [ ] No. of Lines -----2----- -------- Length of a _______________..______ Tota! Length ___________________________ a `D' Box __________ Type Filter Material ____ -----Dept er Material ----1.,9____________-_____-_____---__ (� Distance to nearest: Well ______c5._ __________ Foundation ______��________ Property Line. _4__________________ SEEPAGE PIT [ ] Depth ----------- --------- Diameter ---------------- Number _-_._______________ Rock Filled Yes © No i❑ Water Table Depth --------------------------- --------------- Rock Size Distance to nearest: Well -----------------------------------_....Foundation _______-_ --------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ________-_____________________----------_- Date ________________________________-) Septic Tank (Specify Requirements) ____:__ oq _____ ------------- "=I`l� ------- Disposal Field (Specify Requirements) _ ----------- ------- _— ---------- = - ��_,►� ------------------------------------------, % -------- --- _T -------17��-------------- a_u1 Lr�tn/; X�S _ - tACf__ 1-N -------------------------------- ----------------- ----------------------------- --(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, 1 shall not employ any person in such manner as to become subjje to W man's Compensation laws of California." Signed Owner / - BY ---- -- ------------------------------------------ --Iz--------------- ----------------------------- Title ---------------------------------------------- (If other than owner) FOR DEP .ARMENT USE ONLY APPLICATION ACCEPTED B ______ ____________________________ ---------- --- --------- - DATE BUILDING PERMIT ISSUED ---------------------------------- ------------------------------------- ---------------------DATE ------------- ----------------------------- ADDITIONAL COMMENTS-------------- - ---------------NJOAUIN -= ---------------- ---------------------------------------------------------------------------- --------------------------------------- - ------ - ---------------------- -----=-------------- ------------------------------------------ --------------------------------- -- ' ------------ ------ -------------- --- - -- ------------ - - f Final Inspecti • ------ ---- -- Date j +ld SANCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M