70-819 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: lel- � ,APP_LICATION FOR SANITATION PE7e:�� = - °-------- ------- -3. ,0---- (CompleteD ermit No. in Triplicate) ------------------ -0 -ate Issued/___-3____Zc� -V-------_----------_ _ This Permit Expires 1 Year From Date Iss 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/LOCATI ..oJ---- -= - --" -CENSUS TACT R �� -- -------------- ----=- _-------- hone Owne_r,'s Name - P ••---- Address - -- --- -----�------- City �f u --- 4 Contractor's Name -.. License # J�aZ - Phone _ is. Installation will serve: Residence partment House❑ Commercial :❑Trailer Court l❑ Motel ❑Other ----------------------- , r II. Number of living units:.__�_Ji___--- Number of bedrooms -----Garbage Grinder _ Lot Size -_ f" �--`�------- - Water Supply: Public System and name ------------------- --------------------------------------------------------------- -------------------------Priya te Character of soil to a depth of 3 feet: Sand'❑ Silt❑ "f Clay ❑a Peat E] SandyLdam'❑ 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'{ I � Size---- ----------------------------------------- Liquid Depth f-- ---_-___---____.----- `---- Mi ___------------ s„-------------_------ Capacity TYpe ------- ------- Material ---- - No. Compartment � Distance to nearest: Well - ' L_: ----------y---`'-------Foundation -------'!__`,-----. p. Line ---------------------- Pro LEACHING LINE [ ] No. of Lines ________________________ Length of each' ii ne__'___ _._._----..--_;=_Tofal Length .-_______-.-____-____..__-- 'D' Box --__--.-.__. Type Filter Material ------------- Depth Filter Material --------------------------------------- F t Distance to nearest: Well _._______________ _____ Foundation ------------------------ Property Line ---.__-________.__._.__. SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number„--------.------------------- Rock Filled Yes ❑ No i❑ Water Table Depth --------- --------------------------------------Ro k Size _,----------------------- Distancewto`n crest: Well ---------------!------------------------Foundation ----------`- _.Prop. Cine -------•-.-----_------ i REPAIR/ADDITION(Prev. Sanitation Permit c# -------•--------------I------- ----------------------------------} Septic Tank (Specify Requirements) E --- --- -- ------- ----------I--------------------- - --;----------- 1 { - I Dispos&l_Field (Specify Requirements) ------- - -- ----- - --- )( ----------- ' --------- =--- ------------------- ----------------------------------------------------------------------------- t # -------- ---- 1 IDraw existing and required addition on reverse side) k 1 hereby certify that l.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.” Signed --------- Owner Title ---------------- =-------- - ► (I than owner) FOR(DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------`------------------------------------------- DATE ----- BUILDINGPERMIT ISSUED ---- ------------------------ - ------- -------------------------- ------------------------------DATE ------------ ----------------------------- ADDITIONALCOMMENTS ----------------------------------- --------------------------------------------------------- ---------------- :-------- ------------------------------- ! -------------------------------------------------- ---------- ---------------------------------------------------------------------------- 1 --------------------- -------------------------------- -------- ----------- -------------- ---- -- -------- -- --- - - --------------------------------------------------------------------------------------- -------------- - - qq -- - ------- --i- ---- - Final Inspection by: - ------ Date` i J 3 SAN JOAQUIN LOCAL HEALTH DISTRICT E. k79 1.-'68 Rev. 5M