72-689 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMITc� (Complete in Triplicate) Permit No. I .______________-__-_-_ 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 fp¢yIQ� compliance with-County]Ordinance No. 549 and existing Rules and Regulations. oCl ! 3 1_ . T JOB ADDRESS/LOCATION 5� -a-�r ------------------------I Xli:�------CENSUS TRACT ----`��s--------- Owner's Name ---------- -- - - - - - -- - ------------------------- -- - ----------------------Phone --- - - Address -y ------ ------{---- - ---------- -- -- -------------- --- -------. City ----- C__.<- Contractor's Name ______ /'_ _ _ 1 �/c_�d� .License #0_ ~_&T7__ Phone Installation will serve: Residence fWApartment House❑ Commercial ❑Trailer Court ',❑ II Motel El Other --------------------- t 1 Number of living units ---1.: ______ Number of bedrooms __73-----Garbd a Grinder, -' Garbage- t Lot Size ------------- Water Supply: Public System and name ------------------------------------------------------__---------------- ----------------------------------Private , Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam % Gay Loam ❑ 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.) n NEW INSTALLATION: (No septic tank or ;ep a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK' Size_ Y _�_'Y___4� 1 ----------- Liquid Depth ------ Ca pacity __-_-Capacity --------- Type-_- Material_ - - No. Compartments ____2---------------- /3No. istance to nearest: Well __________57A------------------Foundation -----f 6____._____ Prop. Line .___�`r______________- LEACHING LINE of Lines ____7-,------------ Length of each line_ �a ______ ________ ___ Total Length ______- ---------- 'D' Box _ -- Type Filter Material ---1_.l' _-------Depth Filter Material --------/-I,-------------__ Distance to nearest: Well -------5 A-_________ Foundation -------/_0---------- Property Line .......... SEEPAGE PIT �' Depth __ _.______ Diameter 'y-LP. Number --------_"��----------- Rock Filled Yes)f No 0 Water Table Depth 7-;9:4---- ----------------------- Size -------- --.`-------------- Distance to nearest: Well ______ -:5 _____________________Foundation _----/_"------- Prop. Line ___ 7—�_--.---__-- REPAIR/ADDITION(Prev. Sanitation Permit# --------_--------------------------------___ Date ----------------------------------) •'' Septic Tank (Specify Requirements) ______________________ DisposalField (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 subject to Workman's Compensation laws of California." Signed -------------------------------------------------------------------------------- Owner By ---kl!_ � /!�/ -------- ------- ------------------------------------- -Title ---------------_----- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----�.9�,_©-'---------------------------------------------------------------------------- DATE ----- — P_7 7 BUILDINGPERMIT ISSUED ----------------------------------------------------------------------- ---------------------------------DATE -- ---- --------------- ---------------------COMMENTS -------------- -------------------------------------------------------------------------------------------------------------------------- --------------------- ------ ---------- --- ---------- - --------------------------------------- -------------- -- --------------- ------------------- -------- --- -- - ---- - Fina Inspec ------------------------------Date ---- _ w _ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M