69-148 - Laserfiche WebLink

Home Browse Search

y FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �. - -------------==----------------- ------- (Completein Triplicate) Permit No. ----------------------- ��/ - -- -_ _---�------ Date Issued _________________________ _ __ 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/LOCATIOrt -------d)-----;r -----------CENSUS TRACT ------------------------- //�� 7- ------------------------------- 'J p� Owner's Name -----t�`-'t-��o 0 s �'� ------------•-- ----------Phone Address -�� _ --------�-_-- -�- --------------------------------------------------------- City ---- ! ----------------- ---------- -----------•--- Contractor's Name ---------- --W-- ------------------------------------------------------------License # ------------------------ Phone ----------------------•-•-•--- Installation will serve: Residence 4<Partment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- Number of living units:-----/____ Number of bedrooms ---.Z-___Garbage Grinder /A!___ Lot Size ._, ................. Water Supply: Public System and name ----------------------•-----------------------------------------------•---------------------------------------Privat�,K 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 TREATRhENT [A- SEPTIC TANK[ ] Size_�/_��_ __ _/0-_�__y�'__P`�Liquid Depth ___,V__� __ Capacity _,YgGQQfype _(� _t'ro______ Material _d,$ ---(4_t, No. Compartments _____- ........ Distance to- nearest: Well _____I "-----------------------Foundation ___IQ_f________ 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 _ 4t____ Diameter ______________ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------- ---------=--------Rock Size -------------------------------- S Distance to nearest: Well ______________________-______-_______Foundation ___________________ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------------------- Date -----'----------------------------) SepticTank (Specify Requirements) -----V----------------±---------------------------------------------------------------------------------------------------------------- DisposalField (Specify Requirements) -------------------=------------------ ---------------------------------------------------------------- --------------- ---------------------------- -------- ----------- ------------ ------ - - ------------------------------------------------------------------------- ------------------------------------ (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 Orctinanees, 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." Signedr _ _____ Owner BY --------------------------------------�---------------------- --------------------------------- Title ----------------------- ---------------------------------------------- (If 9ther than owner) EPARTMEN 'USE ONLY K APPLICATION ACCEPTED BY - ------------------ --------------------------- DATE - :'"1�_ BUILDING PERMIT ISSUED - -------DATE ----------- ------- ADDITIONIAL COMMENTS `--- { - �` -----------� / t� , —�- - - ---------------------- - ----- ---- z rL D Qv --•--------- ______________ ______ Inspection b - -------------------------------------------------------------------- - --------------------------- ------------- FinalPY -- ------- ---------------------------------------------------------------_Date --- ^ji' f Sof JOAQUIN LOCAL HEALTH 'DISTRICT E. H. 9 1-'68 Rev. 5M