70-160 - Laserfiche WebLink

Home Browse Search

J FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- -- Permit No. --�----'-�- - (Complete in Triplicate) b Date Issued _-..3/1-31?4 -------- ------------------------------------------------ �� This Permit Expires 1 Year From 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: -7'7 JOB ADDRESS/LOCATION .--� ------�ljL'_'_------- D, l-------------------------------------CENSUS TRACT -------_------.-------..__ '77 Owner's Name ----------------------- Address ---------------- -_ `�1 C,� G? --------- -------Phone -�-- - '� Address c - - City _Cll - -------------------------- Contractor's Name -----------------------License # _1/YJ PhoneJ. Installation will serve: Residence 0 Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ________________________ Number of living units:-----1----- Number of bedrooms __' __-_Garbage Grinder/L_0____ Lot Size --- _• �� ............. Water Supply: Public System and name ------------------------------------ ------------------------------------------------------------•------------Private ❑ Character of soil to a depth of 3 feet: Sand'7 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ Hardpan ❑ Adobeg] 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,) PACKAGE TREATMENT [ I SEPTIC TANK[ ] Size________--___.____---------------------------- Liquid Depth ____--________-___--.-__ N Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ...................... Distance to nearest: Well ______________________-__-_-_-____-Foundation ---------------------- Prop. Line -------- ............. LEACHING LINE [ ] No. of Lines ___ ------------------- Length of each line---------------------------- Total Length ............................ 'D' Box ------------ Type Filter Material ____________________Depth Filter Material ------------------_-.________-.----_--._-.- Distance to nearest: Well ________________________ Foundation ------------------------ Property Line _-______-.-_----__----__ SEEPAGE PIT [ ] Depth -----------.._.----- Diameter ________________ Number ----._-.-------------------- Rock Filled Yes '❑ No ,0 Water Table Depth ------------------------------------------------Rock Size -------------•------------------ Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ._-•___________-----___•-_____-_-_) SepticTank (Specify Requirements) ---------A----- - ------------------------------------------------------------------------------------------ ----------------•-------•-- Dis ie d (Specify Reqs '7� _��L f, ✓_/1l1/. ----G Y---D---- --- --,r'�vo------------ -- `- s -.�r- --------------------------------------------------------------------------------------------------------------------------- -- ---- ------ -------------------------------------------------------- --------------------------------- ------------------------------------------------------------------------------------------- _ 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, 1 shall not employ any person in such manner as to become sybject to W man's Compensation laws of California." Signed ---- -'- ---------- ---------- -------------------------------------- Owner By -------------------------------- ----------------------------------------------------------------- Title ---------- ---------------------------------------------- (If other than owner) ch FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------------------, DATE --1--2-3-1p.---------•--------- ---------------------- BUiLDING PERMIT ISSUED ---------------------------------- ------------ DATE ADDITIONAL COMMENTS ------ -------- ______ Aj Final Inspection by: --- 6 ---•---------------------- ----------------------.Date ---- ------------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M