70-637 - Laserfiche WebLink

Home Browse Search

E FOR OFFICE USE: gpPLICATION FOR SANITATION PERMIT M ...:,. „,, Permit No. :: -- - ------ ---------------- -------------------- :. w )Complete in Triplicate) '-- ------- ------ --- k Date Issued --------------- - ---------- _ This Permit Expires 1 Year From Date issue Application is'hereby made to the San Joaquin ,Local Health District for 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. � ev ------ -- -----CENSUS TRACT JOB ADDRESS/LOCATION _ Phone .._____________________ 0 Owner's Name Tk ------------ ----------------------------- ” Address _ -- I UCity - ----- � _ � i • License # -1�/� Phone '7____ --------------_-- Contractor's ------- � Contractor's Name ------- _ --------- -- Installation will serve: Residence [t partment House Commercial ❑Trailer Court !❑ 4 • Motel ❑ Other -------------------------------------------- / Number of living units:___ _--- N I umber of bedrooms -- � --- ----. •--- ---.----_ ____ _ Garbage Grinder ____.-_- Lot Size .-- -------Private Water Supply: Public System and name ------------------------------------------- Clay Loam Character of soil to a depth of�3�feet:� Sand Silt❑•-, Clay ❑ Peat❑ Sandy Loam ❑ Y L - �.. . --------- _— Hardpan-M-- Adobe-❑rFiEl-Material- =Ef'YeS, type —� buildings, etc. must be placed on reverse side.)" (Plot plan, showing size of lot, location of system in relation to wells, 63; NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) .1 SEPTIC TANK: "' � Size__ _.�-�--�--------- q P PACKAGE. TREATMENT i 7 y t � -�/lJl_ Material_+ No. Compartments ----- - we. Cap acity`6- Q Q_ " TYPe t ' Foundation —--=--------- Prop. Line ?- ----- Distance ----------- 011 dl,-- Total LengthD , ri No. of Lines __ ---------------- Length of h line, - �� .. k f, LEACHING LINE / -__ D' Box _�_/_----TYPe Filter Material Sf _ _QCDepth Filter Material _- -------------�-- - '` __ Foundation _®.------- ---- Properfiy.,.line ®�1 Distance to nearest: Well -.�? ---- ' ..n_ No Depth Diameter -S-------------- Number :------------. Rack Filled Yes ❑ SEEPAGE PIT [ ] p ---- . j-- - -� - Water Table Depth --------------------I-------------- =='.. =___Rock Size ---------------------- --------- - -------- y1� """ Foundation Prop. Line ----- -----• N' Distance to nearest: Well ------------ ---------------- - r k..€ -----) O--------�--- -- Date ----------- -------•---•---•- REPAIR/ADDITION(Prev. Sanitation Permit# -------- -------------- Septic Tank (Specify Requiremel ts) ---- -- --- ------------ ------- ------�------- ------------------------ > Disposal Field iSpecify Requirements) ----------------- }-------• ------------------------------ "+ ---------------- ----------------------------------------- ------ --------------------------- ----------------- 4.. - ------------------------------- --- --- raw g .�,---------------------'-------------------------------------- --------- I i� (Dexistin and required addition on reverse side) I 1 hereby certify that l have prepared this application Re'Regulationsofthe San Joaquin Local hat the work will be oHealth District. Hom'towner or Icen- County Ordinances, State Laws, and Rules a 9 ' 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 be e s Weft to ark s Compensa ' laws of California." Owner Signed -- ---- --- -- ---- -- ----- ----- -- , -- ---------------- k Title --------------- BY (If other than owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ---------------------------------------------------------- DATE ------ ---�, ---- --------------------- BUILDING PERMIT ISSUED ----------------- - ------------ -------------- ------------------------------------ - DATE ADDITIONAL COMMENTS ----------------- ------------ --------- ----------------------------------------- --- ----- -------------------- --- ------- ------- -- - - ----------------------------------------------------- ------ --------- ----------------------- ---------------------- - --- -- - ---- ------ ------ ate Final Inspec io ----- - ----- - ----- - -- -- --- ----------------------- SAN JOAQUIN LOCAL HEALTH- DISTRICT t E. H. 9 1-'68 Rev. 5M