71-137 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: (PLICATION SANITATION PER. / -------------------------- ---------------- - Permit No. _1 _/�-� �-�` (Complete in Triplicate) --------- ----------- 1 ----------- _________________ ____________--_ This Permit Expires 1 Year From Date Issued Date Issued K�': 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 _ ��_-�`�f/ 11-_ ____ -----CENSUS TRACT ___ $__- �_____ Owner's Name L_ C ---------------------------------------------------------- -----------------Phone Address - / r `� -------------------------------- City ` T� ----------------------------•---------- 0 Contractor's Name ------------------------- ;( ------------- -----------------------.License # ------------------------ Phone --------�-----�-----c---------- Installation will serve: Residence ❑Apartment House❑ Commercial (frailer Court i❑ i'r �_"'�J' �C�d` Motel ❑Other -------------------------------------------- Number ------------------------------------------Number of living units:_ _ Number of bedros ----7------Garbage Grinder ------------ Lot Size --- - ----------- Water Supply: Public System and name ___________✓/_11/d __-__________________________________________Private ❑ a Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peatr 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 ----- 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 --------------------------------------------Oft Distance to nearest: Well ______________________ Foundation ------------------------ Property Line _______________________A SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ___ -____ Rock Filled Yes ❑ No 0 pr- e Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation _-.----------------- Prop. Line ______________________ REPAIR/ADDITION(Prev. Sanitation Permit.#_ -------------------------------------------- Date ----------------------____J-1, A Septic Tank (Specify Requirements) -1✓' z_ a"CZ _�C�Lf�% 4- - Dis osal Field (Specif Requi ements) __k ___ _ _ _ _ _ _ _______ _______-__ y �r - �. G c ' &M�Y!7� 5 ------ -- ---------------- --- -- ��' ( w existing d required addition on reverse sidd) I hereby ify 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signe -- ------------------- Owner ---- - --- -- ---- - BY - -¢ •- _ Title (If other than owner _a r F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -V.-`ar e ' - -- e_ - -- --- - --------------- DATE ------------ BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------- - ---------------------DATE ------------------------------------------- ADDITIONALCOMMENTS - ----------------------------------------------------------------------------------------------- ------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- - ------ ----- - ------------------------------------------------------------------------------------------------------------- Final Inspection by: - - '- i------------------------------------------------------------ ------------------------------Date --- �1�----`- � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M