69-373 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: .d�• /�(-----------------f APPLICATION FOR SANITATION PERMIT -161 (Complete in Triplicate) Permit No. -- - This Permit Expires 1 Year From Date 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 compliance with County Ordinance No. 5 49 and existing Rules and Regulations: �l------ �tQ/7v / CENSUS TRACT JOB ADDRESS/LOCATION .�--- - ------- -------: Owner's Name ' /------ G --------------------------------------------------------- ---------------- Phone ------------------------------------ Address -------------------.----- ----Address 124�47S----i4/ � .� etc -- -1_-- - ----------------•--- City ------ � ------------.-.--•---- Contractor's Name ___.__ ----_ _cv�--f��'_______-License # - Phone Installation wilberve: _ - Bence ❑Apartment Nouse❑ Commercial :❑Trailer Court v L //Lcu.�C.t1 of l F-1 Other -------------------------------------------- Number ----------- --- ------------------------- 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 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,) f PACKAGE TREATMENT SEPTICTANK'[ ] Size_ ___x =___ --Z�----G------ Liquid Depth -------- --____-_ Capacity Typ ��z, ',<+ Material_6� Wz- No. Compartments ._. .............. Distance to nearest: Well __ _ ---------- _________Foundation.f -'_2Z2_ Prop. Line ........7--; LEACHING LINE "(j�, No. of Lines '�-�__ -t�'� -_ Length of each line_______________________ ____ Total Length .� _ ' / D' Box ____/_____ Type Filter Material Depth Filter Material _______ ------------------ Distance.to nearest: Well __le-n--- --____ Foundation / ____ _- Property Line ______ _________ SEEPAGE PIT -[ ] 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 ----------------------------------) SepticTank (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, 1 shall not employ any person in such manner as to beta a subject to7e�i- kma .s Campensatip laws of California."r �(J ---------. Owner Signed __ � �'� -� --�=�.`-•�L-fir- . ---- --------- By -------------------------- ----- ------- r ------------ -Title ------------ (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------"---- -------------------- DATE f -7---------------------- BUILDING PERMIT ISSUED --------------------------- ------ -------------------------------------------------------- ---------- -- DATE -------------•--------I-------------- ADDITIONALCOMMENTS ----------------------------------------------------- -=------------------ -------------------------------------------------- --=-------------------------- --------------------------------------=--------------------------= ------------------------------------------------------------------------------------------------ --- --------------------------------- ---------------------- --------------------------------------------------------------------------------------------------------- -- -- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- -------- Date Inspection b -- - -- - ---------------------------------- 4 ~ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. 1