70-604 - Laserfiche WebLink

Home Browse Search

? FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT O Pe ` " (Complete in Triplicate) rmit No: --- ------- -------- _ ______ This Permit Expires ] 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. 5.42 and existi g Rules and Regulations: ` JOB ADDRESS/LOCATION ---------- Owner's Name /-------__--S- _ - r CENSUS TR CT '� --------- -- ----- --RJ--- � Phone .�t� ��`�. ------------- -=-•--------------- Address -- s s------ ------- . Cit t Y p - Contractor's :- Name .--- - ? ' ! License # /,6 �3i -- - ---- ! --- Phone --- 750_77 --• Installation will serve: Residence fkApartment House❑ Commercial:❑Trailer Court [] Motel ❑ Other Number of living units:------------ Number of bedrooms --%?-----Garbage Grinder ____l___ Lot Size f 1 Water Supply: Public System and name ______________ _ _______ Private`K Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ Hardpan;4 Adobe X).= Fill Material -----.-,-.-- .If yes,=type -----'---"--------- ------- (Plot - -(Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKD4 Size_____ ® �Y ----- Liquid Depth ----- ----------------- Capacity /SbO _. Type -------------------- Material-_-- ±---- No. Compartments -_-- 2_---------- . Distance to nearest: Well --------- J'> -----------------Foundation -----Lf------------ Prop. Line ---_____•-_ LEACHING LINE jt(� No. of Lines .-___. ------------- Length of each line-------7.S� hotal Length ___f �'D� f 2 P + D' Box .___'�------ Type Filter Material ___�l-�- -_ Depth Filter Material ------ -- J��____,_- -�--•_____________ �` r �Distance to nearest: Well __ - f------------ Foundation -------/11----------- Property Line. ---- SEEPAGE PIT pQ Depth .___��_�_______ Diameter _ _ ____ Number ____-_----� ________ Rock Filled Yes 0, No r Water Table Depth = '- f� -•---Rock Size � Distance to nearest: Well .-- -----17 ----------------Foundation --------------- Prop. Line ---- _._.. / DDITION[Prev. Sanitation Permit# ----------------- -------------- Date ----------------------------------1 REPAIRADDITION -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 omploy any person in such manner as to become subject to Workman's Compensation laws of California," Signed ----------------------- ----------------------------------"------------------------------------. Owner �y B �� dsa-'�✓ - Title 4 (If other than w erl FOR DEPARTMENT USE ONLY 77 APPLICATION ACCEPTED BY --------- ---------- ----. DATE ----_ --7 __--- -- " ILDING PERMIT ISSUED ------------------------------------------ ----------------DATE ADDITIONAL COMMENTS ----------------------------- ------------ --------------------------------------------------------------------- -- - --- - -- - - ------- ----- -- ------------------------------------------------A--------- ------------- ------- ----- - Fina! Inspection by: --------------------------------------------------------------- ---Dte-------- -------------- -- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 7-'68 Rev. 5M �=