71-074 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE:. / APPLICATION FOR SANITATION PERMIT -17 --------------------------------- �� + ✓ (Complete in Triplicate) Permit No. -__ -- � 7 --------------------------------------------------------- This Permit Expires 1 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 rdinance N_ o. 549 and existing Rules and Regulations: ' CENSUS TRACT �� JOB ADDRESS/LOCATI N __ ______ ____ ____ -_____ __ '_G � l�! �-, �/ ------- Owner's Name -LLc - ' � � -'`' Phon�j------------------------------------ Address cc ` t'- �' ........................................... ( - Contractor's Name ___ _____ _ License # - -ZPhone -- �__ _ - ---------- Installation will serve: es nce Apart enl House❑ Commercial ❑Trailer Court i❑ 'Motel ❑Other ------------------------------------ � ! i Number of living units:________ Number of bedrooms 2-, Grinder Grinder A/_---'___ Lot Size F _✓_X___ ........ // GG��--fix �- �- Water Supply: Public System and name l< �-• 'L ❑ - - -- ---------------------------------- ---------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 'Ea—Fli 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 ifpublic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK,[ ] '_Size__________________________�___--_-___-________ Liquid Depth _________________-_._____- M. Capacity ---- Type -------------------- Material--------- ----------- No. Compartments ...................... _J Distance to nearest: Well _________________________________-Foundation _____________________ Prop. Line ......................%JV LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ---------_................. 'D' Box ------------ Type Filter Material ____-_____-_______Depth Filter Material --------------------_______________ __ ___1�1 Distance to nearest: Well ------------------------ Foundation ___________:________ Property Line ________________________� SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number _________ ---------------- Rock Filled Yes ❑ No i❑� Water Table Depth --------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line ...................... N REPAIR/ADDITION(Prev. Sanitation Permit# _-_____.-__-______________�_______r _____ Date ---------- y Septic Tank (Specify Requirements) - --- --- ---------J_�'--- - ------------------------ ----------------------------._--------------------------- `` Dispo a Field (Specify Requirements) ---•-L-"%�''G'-�`�---------Y-01---- .l*�_�t-[�-------Cy ------ ----- ---•---•---•--- t,_')----- --------- . _S_ 1 _tL-- .-•-----------------------=------ ` ------------------------------------------------ --------- -- ---------------- ----- ------------------ ---------------------------- ------------------------------------------------- ------ (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 subject to Workman's Compensation laws of California." Signed ---------- Owner ---- -- -------------------------------------- j BY ---------------- - _. 1'vU�_� 5, Title , -LL'-1n / ' (I orhe han owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- —----------------------------------------------------------------------------- DATE ----------------- BUILDING PERMIT ISSUED - ---------------------------- ------ -----------------------DATE ------------- ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------•------------------------------------ -------- ---------------------------- ---------------------------------------- ------- ---- ------------------- --------- - ---------------------------------------- ------------------------- s----_------------ --------- ------------- ------------------------------------ -------- - Final Inspection b ___ _ __ _ _ _ ______- __ _ -____-__________Date __ ----- - --- - pY: ---------------------------/---- -- -------! ------ - ----- SAN AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M