73-55 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: � , ;y APPLICATION—FOR SANITATION` PERMIT �s �1` .' Permit No: _.__ = � - r-- -- - ------------------- (Complete in Triplicate} .� •----------- - I Date Issued ----_----_---- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for ap ermit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: f! - --- ---------CENSUS TRACT ---------- JOB ADDRESS/LOC TION ------ --- ----�---- ------------ - z Owner s Name t - ^---J------Phone.----- --------- ----------------------------•--•---- ----- --- ----- CityAddress Contractor's Name -, ---- ----------------------------License #r / _--- Phone ------------------------------ Installation will serve: Residence _partment•_House❑ Commercial,❑Trailer Court [Motel ❑Other-------------------------------------------- Number of living units:--__ .._ Number of b,foo s __ -----Garbage Grinder _ __ _._ Lot ---------------- Water Supply: Public System and name _____ Private _ 5 ❑ Character of soil to a'depth of 3 feet: t Sand'❑ silt C] C�ill Peat❑ Sandy Loam ❑ Clay Loam ❑ Y e --------'-------- Hardpan ❑ Adobe terial __� _ If es,type (Plot plan,`showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} NEW INSTALLATION:tI (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK: Size______�a�,Sl„ --------------------- Liquid Depth ---------..-- q� • Capacity .�_.�------------- Type _ °------4- ° Material- - - ------------- No. Compartments ---------------- --. r s � Distance to nearest: Well __._____ _, /_ 11______ _______Foundation /.-______________ Prop. Lime�`�' - i, 5 �° i LEACHING LINE --No-,--of-L-ines- °---_ : Le►Ygth-o chi line_ _. _e-j7 -- - otal-Length _ Q__�__.......-- 'D' Box Type Filter Material ____________Depth Filter Material -1-17-1"_____ ___________________________ Distant to nearest: Well __ __ _ __ __-_-___ F undation Property Line __zS�_____________ SEEPAGE PIT [ Depth --� __________ Diamet ---- Numbe- ----------------- ----------- Rock Filled Yes g3-- Wo i❑ Water Table Depth --------6---- ------- ------ -- - o f -------•- -- Distance to nearest: Well ---- --- -------------iFoun anon v_________` ro ane ...... i 4 REPAIR/ADDITION(Prev. Sanitation Permit# _-------______-------------------.- -:- Date __----------------------- Septic Tank {Specify Requirements} ---------- --------------------- -------------=--------------------------------------------- ==--------------- ------ DisposalField (Specify Requirements) ------------------=-------------- -------=----------------- - -------------------------------------------------------------------- --------------------------------------- _________________.__-:__________________------__.________.___________________-_-----____.______Y_:__----_____-____________ +r __ _ _ _ ______ ------------------------------------------- --------------------------- - (Draw existing and required addition on reverse side) ` I hereby tcertify 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 become'subject to Workman's Compensation laws of California." Signed ---- - -------------------------------------- Owner �,� -------- Title 17 `'. `_L— ---------- --------------- ! L er than owner) FOR DEPARTMENT USE ONLY I APPLICATION. ACCEPTED BY - --------------------------- DATE BUILDING PERMIT ISSUED -------------- t` --- -- ------DATE --- --- ------------`---------------------- ADITIONAL:CCOMMENTS - ----------- r ---- --- - ---------------------- - ---- -------------- ------------- --------------=-------•------------------- ------------------------- _ ------------------------ --------------- ..------------------------------------------------------------------------------- - - - - -------- FinalInspection by: ------ - ------ --- - -- -- - - ----------------------------------------------------------------------.Date ---- SAN�OAQUIN LOCAL HEALTH DISTRICT �1 E. H. 9 1-'b8 Rev. 5M