75-140 - Laserfiche WebLink

Home Browse Search

',FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT b I � ...................... .............. . {Complete in Triplicate) Permit. No. ..�5.�__..... � ............ .•--.....__... ......... Date Issued „-_- This Permit Expires 1 Year From Date Issued i rj Application is hereby made to the San Joaquin Local,Health district for a permit to construct and install the work herein I described. This application is made ' compliance with County Ordinance No. 549 and exit Rules and Regulations: r AJOB ADDRESS/LOC �� .• ......CENSUS TRACT, ........ .. ... o s hone -----•• .. Owner's Name - . ...... . ........ ... ........................... . ...... .___--•• ...... Cit Address .._...... •--•---_ r -- -----.. .: ense # h 5 . Phone ... _.. ._.LicContractor's Name .. . Installation will serve: Residence ®Apartment House{] Commercial❑Trailer Court [,j i Motel ❑Other................-...........I........... ...._ Number of living units:._.._.._ Number of.bedrooms --- ..... Grinder ............ Lot Size :__l Water Supply: Public System and name ---------- ---------------- . .................................... ...........Private 121_� Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loom. - Clay Loam 0 Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type (Plot plan, showing size of lot, location ofsystem-in_.relation_to wells, buildings, etc. must be placed on reverse side.) i NEW INSTALLATION: (No septic tank or.seepage pit permitted if public sewer is available within 200 feet,) F PACKAGE TREATMENT SEPTIC TANK[ ] Size.......-........................................ Liquid Depth ........................... N ____ No. Compartments ... 0 Capacity Material-----------••--•- .... Distance to nearest: Well ........ ...........Foundation ........................ Prop. line .... ................. t LEACHING LINE ] No. of Lines ....... ... ... Length of each line---------------------------- Total Length --------- .............. 'D' Box ------------ Type Filter Material ...........:.........Depth Filter Material ----E.___......- ... Distance to nearest: Well ..::.........:.•---•-:- Foundation- --..-Property Line --�---=..__......� SEEPAGE PIT j j Depth .................... Diameter ............... Number ............_-.............. Rock .Filled Yes ❑ No I Water Table Depth,....,_............ .Rock Size Distance to nearest: Well .........................................Foundation ____________________ Prop. Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit# ...............................•............ Date ----.------------------•-----•----) j. �._.�............................... Septic Tank (Specify Requirements) --------•--...._..__.....................•---------�----•-----.....--- ----•-••--•---•-------._.... Disposal Fi lcl (Specify Requirements) t ... a � ..... .-------•--• ------------------------------------------------------ ----------------- --------------------------------------------------------- -.................................................................---.......................... (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 ticen- 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." iSigned ------------------_-------.... . ........... Owner . By �.. __ . ... --•----_ 'Title _.... :....::............... -- _........... . ......... .... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------- °-........................................................................... - DATE .... :................................ BUILDING PERMIT ISSUED .................:........... ADDITIONAL COMMENTS ..................... ..............._..-.......................................................•-• .................... .....------------..................................................................._....-----......_..........------------•-•------......_.......------._.......Date'... •. ..................... .......... Final Inspection by: G=ir-.•-•-----------......... ••-----••---------.......----.._............ �7 SAN JOAQUIN LOCAL HEALTH DISTRICT u 1.3 24 t.-AA Rp„_ 5M 7/72 3 M