74-702 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � a ---------------------------------------------------------- ---"--------"-"------"" (Complete in Triplicate) Permit No: .:.7 - -__7az ____. .......... -- ------------- -- ---- ------ ------------- Date issued ._8"��' _7(/ --------- This Permit Expires t Year From Date Issued ------- Application is hereby made to the San Joaquin Local Health District for a permit to construct arid 'install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT19N ------- - --.--- CENSUS TRACT -------------------------- l -- --Te �'X G " Owner's Name ""- _- - -- - Phone ------------------------------------ Address -------- .___:_____ Address / __. city ----------------------------------------- -- Contractor's Name _.___ _( � - __�_`i�___- License � __ PhoneYO �s _� ,� Installation will serve: Residence Apartment House❑ Commercial .❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- 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 .E] 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,) S' PACKAGE TREATMENT f ] SEPTIC TANK'[ ] Size-------------- -------------------- ----------- Liquid Depth ------------_---_.------ � Capacity --------------------- Type -------------------- Ma rias------------ ----1--- No. Compartments ------- ... .. Distance to nearest: Well ------------------------ -----------Foun ation ____-__-.--___-_____ Prop. Line ________._...___----- LEACHING LINE [ ] No. of Lines ________________________ Length of ach line--- _____--_--_----__-_ Total Length ,'D' Box ------------ Type Filter Material ___________________ epth Filter Material _.____-________._ Distance to nearest: Well ------------ --- ------ Foun ation _.__________.________ Property Line ________________._....__ SEEPAGE PIT :[ J Depth ---------------- -- Diameter -___-__-_--._ -. N njber __--.____------=---------- Rock Filled Yes ❑ No i❑ 9�i, Water Table Depth ------------ Nle Size -------------------------------- Distance to nearest: Well _--__________________ ____ ___________Foundation --------------------- Prop. Line -------------_------ REPAIR/ADDITION(Prev. Sanitation Permit# _: -___-.___---________ "_""r____.____._ Date --------------------______________} Septic Tank (Specify Requirements) --------------------------------- --------------------------------------------- Dispo al Fi ld (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 employ any person in such manner as to become ubject to Workman's Compensation laws of California." Signed --- -- ---------- ----- n ------- , - Owner By --- --------- -- ----- ------------- ------ -- -------- Title ------------ 1. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------------------------- ---- DATE -.27-G7!Lt-------------------- BUILDING PERMIT ISSUED - --------------------------------------------------------- ----------- --------DATE ------------------------------------------- ' ADDITIONAL COMMENTS ----------------- ---------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Fin -------------------------- ---- __ _------------------------------------------------------ --- --------- �; �;�1.,� -- ,. - - a nspection by: ------ ------------ -- -------- - Date ------------- ------------ --- . SAN JOAQUIN LOCAL HEALTH DISTRICT W i E. H. 9 1-'68 Rev. 5M