72-1147 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------- (Complete in Triplicate) Permit No: � -- - -------------------------------------------------------- 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION __J-- v.___._��_ _P` _'kl_ ---- ----1� -CENSUS TRACT ---------��----•-- g Owner's Name --------- r� ------- ------------------------------ -------Phone � �P----!__----- Address --------------------- =l---T 10------ __<._-- .. ` ll—a Cit �'� Y Contractor's Name -- ----- ---r---- CT -r 61 License # ------- Phone _ b____ 667. Installation will serve: Residence ❑Apartment House`E] Commercial :❑Trailer Court ',❑ Motel ❑Other --- -------- Number ofliving 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'b-A Sandy Loam -❑ Clay Loom ❑ l � Hardpan ❑ Adobe'❑ Fill Material ----------- If yes;type---------------------------- .(Plot plan, showing size of lot, location of system in relation to vkells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pi permitted if public sewer is avail ble within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK, I Size________________________----------- ----- _ ____ Liquid Depth -------------------------- Capacity _-______._______Capacity -------------------- Type - ----------------- Material "= `- ------------ No. Compartments ---------------- Distance to nearest: Well ------------------------------------Foundation ___. ..'.____-__ __i Prop. Line ______________________ LEACHING LINE [ ] No. of Lines ------------------------ Length of each line-----------------____-- _-- Total Length ----_----------------------- 'D' Box ------------ Type, Filter. Material--------------------Depth Filter ateriai --------------------•---------.--.,---.--_._ Distance to nearest: Well ----- ---# ----- - --- Foundation _ __ ._.-_ __------Property Line ________________________ SEEPAGE PIT [ ] Depth ___________________ Diamete _______________ Number ------------------- .......Rock Filled Yes ❑ No ❑ Water Table Depth --------------- -------------------------------Rock Size . M - '---------------------- Distance to nearest. Well ______ -------------________________Foundation __ —.__.*___ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ------ - --------------------------- Date -------------- -. -------- Septic Tank (Specify Requirements) ---- ----------------------------------- --------------------- Disposal Field (Specify Requirements) ------ -� 1 - ------- --- ------------------------------------------------- __ - -------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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: __ `' 1 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 BY ------- Title - - ------------------------------------ -------------- (If oth hon owner) j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- f DATE BUILDING PERMIT ISSUED ------------ --------- -------DATE ------------------------------ ------------ ---------------------------------------------------------- 1, ADDITIONAL COMMENTS --------------------------_--------------------------------------------------------------------------------------------------I------------------ - ------- ---------------------------------- ------------- ------------------------------------------------------------------------------------------------------------------------•-------------------------------- ` 4 _---------------------------------------------- �/ 4 f = - - ---------- --------'--------------------------------------------------yam - Final Inspection b P Y ---------------------• ------------------ ------------- Date =_7 .9 -- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ��