70-84 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------- ----------------------------------- - (Complete in Triplicate) Permit No. -------- --------- ---------- - ( __-___-_____-___ -11-0 - -1�-- _____ _-_-_____ 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 ......... --------------------------- ---------------CENSUS TRACT -------------------------- Owner's Name .------- -------- --------------------------------------------- ------Phone Address2 1 ` '2------- ----------------- ----------------------- City -- - --------------------------------------------------•------ Contractor's Name - ---------- ------ -----------------------------------------------------------------.License # ------- ------------ --- Phone ---------------------_---•-- Installation will serve: Residence ['Apartment House,❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:---- _----- Number of bedrooms ___�---Garbage Grinder ----NLO Lot Size -----------------------------__-__--_;____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 ❑ 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 SEPTIC TANK Size--------------------------- -------_------------ Liquid Depth ------------.____-_,_____ Capacity [Z V Type --------------- ---- Material_____-`G------- 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 [ ] Depth --------- ---------- Diameter ---------------- Number --------------------------.- Rock Filled Yes ❑ No i❑ WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ___________________________________-Foundation ----- -------------- Prop. Line ___--______-__________ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ____-------- ________________________----__ ..---.---- ------------------- ---------------------- - ---- ---------------•---- Disposal Field (Specify Requirements) _______ __ �_�_�______.-_\\ L.--- i� �ti_------ ---_--------------------- ---------------------- - ------------------- (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 blect to rkman's Comp n laws of California." Signed -------------------------- Owner By ----------------- -------------------------------------------------------------------------- Title -------------- ---------- ------------------------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ----------------------- ---------- ----------- DATE —Q-7-47-70— --- ------- BUILDING PERMIT ISSUED ------------------------------------------------------------------------------------------------- . .DATE ------------- --------------------- ------- ADDITIONAL COMMENTS -------------- ------------------------------------------------------------- -------------------- ----------- ------------------------------------------cs-------------------------------------------------------------------------------------------------------------------- -------- ---------------------------------- Final Inspection by: -, _ - -I- ----------------------------Date -- - � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M