68-489 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------- (Complete in Triplicate) Permit No. - --- --- --- -- --------------------------------- >,—This Permit Expires 1 Year From Date Issued Date Issued 'c'�_:_ - _- � 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/LOCATIO 3 --._CENSUS TRACT - Owner's Name -----____-- _Phane'?:31: U_ __3---- s :b Address ------- --------- --------- - -- City � � -��"'' .. .. ,. � ,, � - - - -------- ---------------------- -'= - = '� � acens Contractor's Name ---------------- = - Phone r f Installation will serve: Reside�cceApartment House,[] Commercial ❑Trailer Court '❑ Motel ❑ Other Number of living units:----- .___ Number of bedrooms _____Garbage Grinder .-h-10--- Lot Size ____.___- __--_---- Water Supply: Public System and;name________________________________ ____ _ Private - -------------------- Character of soil to a depth of 3 Beet: Sand' Silt Cla ❑ ❑ y ❑ ,Peat❑ Sandy Loam ❑ Clay Loam Hzardpan ❑ Adobe-E] Fill Material _ :___-._ If yes, type ________________________ /� . (plot plan, showing size.ofF lot,.foca on of system inrelati6n to wells, buildings,.ietc_.,must be placed-on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is availablenwithin 200 feet,) PACKAGE TREATMENT [ ] SEPT I.C.7AFNK [ ] ` , Size____ __ --_-------1,------ .s------- ;. ____------- - Liquid Depth -------------------------- R.. Capacity -------------- '- Type'-7--------- -Material------- __ " No. Compartments -------------•--_-- , Distance to nearest: Well -------------------------------------Foundation _ ------ Prop. Line -------------- ..----- LEACHING LINE y :. [ ] No. of Lines ------------------------ Length of each line---- ----"- - ----- Total Length -----------•-____ _________ D' Box ____________ Type!Filter Materia! __ -±_____________Depth--ter Material ----------------- ", ---------- 1. '.Distance to nearest: Well ______________________ Foundation -.__._ ------- Property Line SEEPAGE PIT [ ] Depth ____________ __^t Diameter -^- -__-�-_ Number Rock Filled Yes ❑ No i❑ Water Table Depth _= ------ ------ Rock Size Distance to nearest: Well -------------------------------•--------Foundation -------------------- Prop. Line -.-------------------- REP AIR/ADDITION ---------------. -- REPAIR/ADDITION(Prev. Sanitation Permit# -------- --------------'z------------------- Date ------_--_-------------------_-_--) I Septic Tank (Specify Requirements) --------------------- �_' ------------------------- Disposal Field (Specify Requirements) i_>-V - -- - ---- --- > ---- - 006&x------------------ - ----- ---- - -- -- -- . (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 perfbrrnance of`the W—&k•for`which this perrrdt is issued, 1 shall riot employ driy person in such manner as to become subject to Workman's Compensation laws of California." Signed -- -----------'----- --- ---------------- Owner ------ ---- -------------------------------- BY ....... ' - -r--------------- Title ------- '------------------ ---- - [ of er an owner) \ ,4jr rs f FOR DEPA-k ENT USE ON 4 ;�;APPLICATION A�CE�PTE�DBY .- _-- ------, DATE _- _-- .. ----------- ------ - ---- --� - ------------ �.. BUILa1NG PERMIT ISSUED _________________ -------• �--------- -- ----------� ----- -------------------------- ------- --------1--------------DATE - --------•----- --------------- ---- ADDITIONAL COMMENTS ---------------- - r ----------------------------- ------------ ------- �r�f---- °d�` � � P__._ � --------------------------------------_____.-------- --------------------------------------------- BUILDING _____ f __________________________________________________________________________________________________________________________________________________ __ _ ____________________________________ _ - _._______-____ __ Final Inspection b 1T - ---- ------- - - - ---- -- - P Y " - �--------------------- ---------------------------------------------------------------Date __� 1- _ . ..- - f SAN/JOA�QUIN LOCAL HEALTH DISTRICT �� Fo E. H. 9 1-'68 Rev. 5M