68-700 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: (Complete in Triplicate) �G'd_ ---'----=--------'-------------- •-------'-------------= _�J ________ This Permit Expires 1 Year From Date Issued Date Issued _7_-�!J' _----' 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 Od Regulations: ! sr JOB ADDRESS/LOCATION -__=; '. _- ---- ---- ------- ____ d,�_1�Z_G'__ 14`__ �_��c��CENSUS TRACT ------- -------_---_. Owner's Na/m�e! -f _ - ------------------ '_ ) _L/-------------------------------------------- Address -------------------- -----------=�/---- �r r�Phone Address " = - �`�Jr- ��, Cit bCi lis/ Q ----d�----- -- - - o Jia s�y Contractor's Name 1 e �1/ � 7 �'�--- - - J-.!. Installation will serve: Residence � Apartment House Commercials❑Trailer Court Phone 3 Motel ❑Other -------------- ----------------------------- I Number of living units:--__ ----- Number of bedrooms _-a ______Garbage Grinder Lot Size _Ve/-0_f' Water Supply: Public System and name ---------------------- ----•---------------------------------- ------------------------- ----------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam -❑i Clay Loam;❑ ' Hardpan Adobe ❑ Fill Material NO-___ If yes, type ____________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings,�etcc must be placed on reverse de.)' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size________'_________________--------------- ---- Liquid Depth Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ------ Distance to nearest: - ------ Well ---------------------------------- _ Foundation -------------- ---- Pro Line -------__-� LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------'------ Total Length -----------.--_-;__..._.•._ 'D' Box ------------ Type Filter Material --------- ----------Depth Filter Material ---------------------------------'---_.----.- ce to nearest: Well ------------------------ Founda - '" Property Line --------------- '1 M SEEPAGE PIT j Depth _____I_ ________ eterr' .l_ '__ mber .___.___--__�_- Rock t=illed Yes 6 0 Water Table Depth --------------------- -------------------Rock Size -----��---------------- --- Distance to nearest: Well _ -- - --G-------------------------- at',on C ro p• ---- ----------- REPAIR/ADDITION(Prev. Sanitation Permit# ---------- __________1--------------- Date ---------.____._____________ ) i SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------,..- ----------------------•- Disposal Fielsl (Specify Requirements) ---- {�T -f------------D-------&)X__-_____ -_-_--1-1 1t-�------- To-------- X Q '---------- --= ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 Distriet. Homeowner or liven 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 e4 to Workman's Compensation laws of California." Signed become subj - ykm' - --- --------- ----------------------------------- Owner ByB Title -------------------`----------- ----------------------------------- (if other than owner FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---��r-jl. ------------------------------------------------- DATE ------ `rte ------ BUILDINGPERMIT ISSUED --- ------- ---------------------------------------------------------------------------------------------DATE ------------- -------------- ADDITIONALCOMMENTS --------- ------ --- ------------------------------------------------------------------------------- '---------- . ----------- __-- - _. ... -- -- --------- _ - ------------- - Final In: ection9 a#e SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.