71-375 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT // �/ : .Permit No. (Complete in Triplicate) ' - - -�------------- ------ --------------------------_ 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 ._ OX161Z--- .---------CENSUS TRACT.--------- ----------- .1�_� 4 +Z Phone.03 ----- Owner's Name Address --- �-r`r - City, ------------------------•-------••-•------ 7:51Contractor's Name -Al-4`1 ----------License # tf Phone _ Installation will serve: Residence ❑ Apartment HouseKCorhmercial :❑Trailer Court ;❑ Motel ❑ Other ------------------------------------------- Number of living units:--`_ Number of bedrooms _ -Parbage Grinder ---.----tot Size �C�_��-�------------- � Water Supply. Public System and name ------------------------------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑�, 'Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ Hardpan ❑ Adobekfl 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 f ] Size----------------------------------------. - quid Depth -----------.------ Ca acit Type ------------------- Material---------------------- No. Compartments --------------•--=---- P Y --------------- YP � Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ------------- --------- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line-----------------------i____ Total Length ----------- ---------------- 'D' Box -------- --- Type Filter Material --------------------Depth f=ilter_ Material -------------------------------------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line. -------------------=---- SEEPAGE PIT [ ] Depth ________________ Diameter ----------- ---- Number ---------------------------- Rock Filled Yes ❑ No .0 WaterTable Depth --------------------------------------- --------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----.----------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 Septic Tank (Specify Requirements) -- ------------------------------------ ' Disposal Field (Specify Requirements) -: Q ---- ___ o� �� f �--- 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: "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 su ect to Workman's Compensation laws of California." Signed ------ - --- '------------------------------------------------------- Owner BYTitle ------------------------------------------------------------------------ ---- (/Ker than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- --------- ------ ---- - ---------- ------------------------------------ DATE BUILDINGPERMIT ISSUED ---- -------------------------- ---------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS ------------ ------ -- --------------------------- -------- ------- -------------- _r� - ---st` s --------------------------- ------------------------------------------------- ----------------------------------------- -------------------------- --- -- --- --------------- ----- -- ------------------------------------------------- --- -- Final'Inspection by. Date -------- ---- -- ------------- - - SAN OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �"