70-750 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: / APPLICATION FOR SANITATION PERMIT ��ff _ ---------------------l 9 ' !" s !d 7S (Complete in Triplicate) Permit No: ------------ This Permit Expires 1 Year From bate Issued 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 with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ---. ( ----- .- --------- --------- ----CENSUS TRACT -----------------_-------- t Owner's Name - ----- ----Phone Address _----------- --�'��--�-----•--- ------------- -- ---------------- ------------------ City �:c-�� j°,��j- -------------- Contractor's Name �_ Q___---. i "-'�� ------------------------ -----.License #/��.�� -- Phone t2/Z4 # Installation will serve: Residence ❑Apartment House❑ Commercial $Trailer Court ;❑ 1 Motel ❑ Other Number of living units:_..__ d ___ Number of bedrooms __0-._..-Garbage Grinder,e..��_-_ Lot Size �� ' ,o0'-e._ r a---!------------- Water `------------- Water Supply: Public System and name .................._-._.-_. ---Private ' Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 'g Fill Material ...____--_-_ If yes,type .______________________ t _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) f_, NEW INSTALLATION—, (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) W PACKAGETRE'ATM=NT SEPTIC TANK -- _ - - _ - -------------------- Liquid Depth / ----------------- Capacity i Ca acitY ��---__ TYP � D Material-_C1a.0�7ef-__`' No, Compartments .... -........._ ` Distance to nearest: Well ...__ �' _ �� -�---------------Foundation _ ��-------- --- Prop. Line .e��-----•-•- LEACHING LINE A No. of Lines ------ -------------- Length of each line-_� �._,_ -__ Total Length _ 4�w � --------------- D' Box/ &*-- Type Filter Mate ria]/1�1 4& Depth Filter Material �'. 41 ----------------------------- .41 Distance to nearest: Well _ ./---------- Foundation ___________ Property Line ,� .�-----___ SEEPAGE PIT [ ] Depth -Zed--------- Diameter,/_V 6.8 Number -------f Rock FilledYes fi4 No i❑ Water Table Depth ..___ � ------------------- Rock Size Distance to nearest: Well .____- -- Foundation _c -------------- ___---'---- Prop. Line ---------------•------ REPAIR/ADDITION(Prev. Sanitation Permit# ________ ---------- ------------------------- Date Septic Tank (Specify Requirements) ------------ ------------------------------------------------------------------------------ Disposal Field (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 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 -- ------------ BY - ----------- -------------- /� Title -- - -- -------------- {If o than own �.+�"�'ati-- '--------- --- - --- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- __ . -- -- - --------------------------------------------- ------------ --------------. DATE �a BUILDING PERMIT ISSUED ---- ----- ----- ��----------------- ADDITIO AL COMMENTS TE -- b �, & ---�'�-------TT-L -------------- ---------------- -------------- ----- ----------------------- ----- - - `f s !? ry ---------------------------- ---------- f/� .� --------------: ----------- -- --------------------------- ------------- - , Final Inspection by: - ` Date --- ----- -------------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT ' E. H. 9 1-'68 Rev. 5M