68-890 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. (� -------------------------- --------1�=M_ _ _ --------- This Permit Expires 1 Year From Date Issued 11 Date Issued ZO_=%S 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/LOC ON ._ ��i- ----------------- ------------- ------------- -----------CENSUS TRACT .------------------------ Owner's Name ----- - -------------------------------------------------- - Phone - �i Address _____ _ SZ-- - - City � yc'=----------------------------------•-------- Contractor's Name ------------------------------------------------------.License # ----------------------- Phone -------------------_--------- Installation will serve: Residence IN Apartment House[] Commercial ❑Trailer Court ;❑ Motel ❑Other - _l Number of living units:------------ Number of bedrooms ______Garbage Grinder ------------ Lot Size _��-- 1.--_- Water Supply: Public System and name ------ t -Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe X 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 ___--_-7777---__ Type ---_--------------- Material---------------------- No. Compartments A, t Distance to nearest: Well ------------------------------------Foundation _.__ ----------------- Prop. Line _-_____---__e___._.-- \ �LEACHIN [ ] No. of Lines --------f-_ Length of each line_______7-D_____-7777__ Total Length ,____7,L?---------------- 'D' Box -___------- Type Filter Material �P_�kr_yq<Qepth Filter Material ---___--Y-._9 J r, --- ---------- Distance to nea est: Well _�____________-7777_ Foundation d. L i r ° b Property Line -} SEEPAGE PIT [ ] Depth ---- --------_-_ Diameter )7777-. Number -------/ -----------_--_-- Rock Filled Yes � No ❑ Water Table Depth -----------4-10 , � ----------------------------Rock Size -- ------Ati-b t Distance to nearest: Well ----7--------- ............Foundation l'C/ .lQProp. Line ......... REPAIR/ADDITION(Prev. Sanitation Permit# __-- --------------------------------------- Date __-_7777_-__-_-__________..______)� Septic Tank (Specify Requirements)Itsi ltDisposal Field (Specify Requireme f __ i _-_-_- __ .-Q,� ---y -------------------------------------------------------------------------------------------------------------------------------------------- - - ------ --- - - ---------------------------------- (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 becomT ject to Wor man'sZCoensatton laws of California." Signed __-_ ------------------------------ Owner BY - -------------------------------------- ---------------------------- Title (If other than owner) -- DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- l�----------- DATE L`1 BUILDING PERMIT ISSUED ------ - -- ---- --- ADDITIONAL COMMENTS _- - --- DATE -------------/- ---------------------------- _ - __ - _ __ ______ _ ------------------------ y U -fid a4 c r� - -/ - " h � _��/ . ------- inal Ins ction b - ---------- =-- -- Y� -------- - �y-' -------------------- - ------- -- - - - ------- - -- ------------------.Date --- -.."/�-,��' -----------•-___ �. N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M