70-533 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT c Permit No. (Complete in Triplicate) --- - � = � �7 Date Issued ____------------ ---------- 1. 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/LOCATI - -- ---1 —--- --= --------------------------CENSUS TRACT -------------------------- ---------- -- - � Owner's Name _Phone-1�-------1!`i.-eQd - - - - �- ----------1-�-- ----------------------------------------,------------------- ------------ ------ � -------------------- Address ----_. Cite- ---=-- - - - - - Contractor's Name ______ 0 - License #t- .s•�� Phone Installation will serve: Residence Apartment House,❑ Commercial ❑Trailer Court ❑ /7��x Motel ❑Other ------------------------------------------- 1 � Garbpe Grinder __________ Lot Size ___ -- Number of living units:__________ Number of bedrooms _. _ ____ 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 ------------------_-_______ �A (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) Ilk NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size------------------------------------------------ Liquid Depth __._----_---------------- Ca acit 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 [ ] Depth -------------------- Diameter _______________ Number ---------------------------- Rock Filled Yes ❑ No i❑ WaterTable Depth ------------------------------------------------Rock Size ---I----------------------------- Distance to nearest: Well __________ ------ ----------------------Foundation ------______-------- Prop. Line _.___-_____.____-.-_-- REPAIR/ADDITION(Prev. Sanitation Permit# }------------------------------�------QDate ------ --------------------------- Septic Tank (Specify Requirements) ------------K -. `� -..---- Disposal Field (Specify Requirements) -------------------------------- ---------------------------------- --------------- ---------------------------------------------------------------------------- ----------------------------=------------ -------------------------- - ------------------- ---------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 4 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - --- ------------------------------ -- ---- -- --t-- -- ----------------------------------- Owner BY /�� Title "-_16:`"`'` t - --- (if o than owner) OR DEPARTME T USE ONLY APPLICATION ACCEPTED BY --------- -------------- ------------------------------------------ DATE -------------- ---- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------------------DATE ------------ ------------------------- ADDITIONALCOMMENTS -------------------------- --------------------------------------------------------------------------------------------------------------------------- ------ ------- --------------------------------------- - - ------ - ----- -- ----- - ----- - -- - ----------- ------- --------------------. ---- ---------- --------- '------------------------------------------------------------- ---------- ----------- Final Inspection by: ----- -- --- --- ------------ Date SAN JOAQUIN AL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M