75-231 - Laserfiche WebLink

Home Browse Search

`N 7 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .. ...._-.- '23 . .................... Permit No. .�......._........ (Complete in Triplicate) .0. This Permit Expires i Year From bate Issued Date issued . `......:...... Application is hereby made to the San Joaquin Local Health District for a per 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/LOCA N .. .. ..••.. - • - . _ ...................1....-CENSUS TRACT ..........--• ::....,.:.. Owner's Name ....... ..... ... ....... _.. ...... ...... ...........Phone..................................... ` Address ._... � 7 -. . -- --- - ------ --- ..... City --.. .. .. ...........................-........................ EContractor's Nome .-....._ •. ...... .. . ..... ------_-:...License # ..��gr _ yPlione .............................. Installation will serve: Residence Apartment House Commercial .❑Trailer Court 0 11 Motel ❑Other ........... .........::................... Number of living units:..... Number of bedrooms -.-; ;.....Garbage Grinder ............ Lot Size .... - -- _.-._...- 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 ❑ 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.) 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 _-............:.._........... I 'D' Box ............ Type Filter Material ....:..Depth Filter Material .........................................:... Distance to nearest: Well Foundation ........................ Property Line .... ..:-•.............. SEEPAGE PIT I j Depth ...........:........ .Diameter . Number ............----........ Rock Filled Yes ❑ No ❑ Water Table Depth ...---....Rock.Size Distance to nearest: Well .•......................................Foundation ---------._._._..... Prop. Line ------.--..-----...... REPAIR/ADDITION(Prev. Sanitation'Permit# ............................................ Date ..................................I i Septic Tank (Specify`Requirements) i Disposal Field (Specify Requirements) -_---------•----------•-•--------•--- --- -•-------------- ---------------------•--• .......................... ................ ------ - ------ - --- ----f ----- -- -- --------------_-.........--•...............................:-............................................. Draw existing d 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 Rultis and Regulations of the San Joaquin Local Health District. Nonce owner or llcen- sed agents signature certifies the following: "1 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 T!tie By . (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........... .:. .....................................................:............................, DATE ...�_.'1 ..7A._.._...-----.... BUILDINGPERMIT ISSUED ....•..................................:.....••-------------..................•---....._....----...._.....DATE .-- --------•--•-•-•-- --•- ADDITIONALCOMMENTS ...........................................•----..........-•-------.......-------• ------...._............._......------...---......._.............--------... _-------•---..._ _-•--•- ---------' ......................•---...-----------•-••-----....._-*........__. ........._._.... J....,....... _.._ Final inspection by: r , .... -.........Date . 11 ._ �................... i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'GB Rev. 5M — - 7/7�_