71-697 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USf: � APPLICATION FOR SANITATION PERMIT --- - �.; - Permit No. (Complete in Triplicate) ----------- This Permit Expires T 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION,-� r 6/t _Ad---- ENSUS TRACT ------ ------------------- Owner's Name ___-- 1 P�h}one ------------------------------------ Address ------------- -r .$tf _. -. City �S� 1e ' "± r � Contractor's Name - -- --------------------- # 138Phone Installation will serve: Residen e ❑Apartment House❑A Commercial :06raile:r Court ;❑ Motel ❑Other ---- ae -7�71 Number of living units:___.__ Number of bedrooms -----(-----Garbage Grinder ------------ Lot Size __________________________--_-_---________ I Water Supply: Public System and name ---------------------------------- ---------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Rl� Peat❑ Sandy Loam -❑ Clay Loam ❑ i Hardpan ❑ Adobe ❑ Fill Material If yes, type _________________________ _ ,1 (Plot plan, showing size of lot, location of system, in relation to" wells, buildings;.etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or sWP age pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size__$__X11 -' '--, --------_-- Liquid Depth-1 __1...... --------- Capacity _Z- 400_ _ Type � cE�_ Material-_ -dam__ No. Compartments -_" .....____.. Distance to nearest: Well ----------/_0D------------------Foundation -----L4----------- Prop. Line ------ --------- LEACHING LINE [ No. of Lines --------0------------ Length of each line____---7P--A----------- Total Length .4?1-1'A_---____________ 'D' Box __-- -- Type Filter Material ----S_R.------Depth Filter Material ------ --------------------- j Distance to nearest: Well -------1__0.0__'______ Foundation ---------- Property Line ----- ........ SEEPAGE PIT [ Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No C] Water Table Depth ------------------------------------Rock Size -------------------------------- { Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) --------- --------------------------------------------------- ---------------------------------------------------------- Disposal Field (Specify Requirements) ---- ----------------------------------------------------------------------------------- ------ ------------------------------------------------------------------------------------------------ ------------------------------------------- ------------------------------------- -------------------- --- ---- -- Draw 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 j 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 ---------------------- - ------- --------- -- -----j------- ------------------- Owner r BY ---------- --------- .. �' ----- { w' -t`i Title `e ' (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ------------------------------------------- --------------- DATE _7-. 2-'. �------------------ l BUILDINGPERMIT ISSUED -------------------------------------------------------------~------------------- -------DATE --------------------------- ADDITIONALCOMMENTS ----------------------------------------------------------------------------------------------------------------------------------=--------------------------- ' _- -------------------------------------------------------------------------------------------------------'-------------------------------------------------------------------------------------------------- ---------------------------------- ---------------------------- ------------------- -- -- -- - --- -- -- -- -- --- - - - ----- - - - -- - Final Inspection by: ---------------------------"------------------__- ------_-----------------Date" -7 `% ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M t