72-763 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �a -------------------------- ------------------- ---------- i Permit No, (Complete in Triplicate) ------------ ---------- ---------------------- '',: -.: ,»: � �- .. -. Date Issued ---_-----------_--- --------------------------------_ This Permit Expires l Year From Datelssued 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: i JOB ADDRESS/LOCATION . J� ------V- --� yl---------------- ----- ------------------ CENSUS TRACT Owner's Name ------ r ----------- -------------------------- Phonefl/ ---e--��--7-3 Address -------------------------- f --------- =�rr�------------------. --------- ' -- ---------------------------------------- Contractor's -------------- - ----Contractor's Name _,_ _---_-:- _" -- -- I !C� License# .�_ ��t Phone L Installation will serve: Residence Apartment House-0 Commercial :❑Trailer Court ;[ --- Motel F-]Other -------------------------------------------- _77- Number of living units:-.---_-1--- N- Aber of bedrooms ------3----Garbcge'.Grinder ---------:- LotSize -__ 6__ _f.Z�------------------ Water Supply: Public System and name ----------------------------------------------+---------------------------f--u ` -'-------------Private ❑ Character of soil to a depth cif 3 feet: ' Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ i i Hardpan ❑ Adobe' Fill Material -------- If yes, type ---------------------------- r< (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,) ` i PACKAGE TREATMENT [ SEPTIC TANK'[ ] Size-----------------------------.------------------- Liquid Depth ------------•------------- Capacity -_-- _: "Material---------------------- No, Compartments Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------------._.... �J LEACHING LINE [ ] No. of Line - --- s - ------ ------------ Length of each line------_�------------------ Total Length -----------._-_------ ---- 'D' Box --_f ---- Type Filter Material ----------- --------Depth Filter Material -.---.---------____.-__--__----..-...:..-_ 1� Distance to nearest: Well -.--_ _`..--____:_ Foundation :_'�__________-_-----_ Property Line -_------------------ -- % h A ` SEEPAGE PIT [ ] Depth• __.------------------ Diameter ---------------- Number ----------------------_---- Rock Filled Yes ❑ No i❑ WaterTable Depth ----------------------------------------------- Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line --------___...... i REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------- ------------ I Septic Tank (Specify Requirements) ----`--------- ------ --- ------------------------------<------------------------ -- 1 Disposal Field (Specify Requirements) ------------ ';: Q � '�C "''�"`-------------------------------------------•----------- ------------------------------------------------ "� ------------ a_-------- ----------_- - -- -------------------- k� " ------------------------------------------------------------------------- `(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 - --------- `------ U&------ --------------- Title (If of than owner)j 1 [ - FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . DATE BUILDING PERMIT ISSUED ------ -------r------------- -- - --- ------------------------ --------------DATE ---------------•------ ADDITIONALCOMMENTS --------------- ------------------------------- --------------------------------------- --------------------------------------------=-- ------------------------- -------------- ------------------------------------------- --- -•---------------- r � / -------------------------------- _-. ------------------------ ----- ----------- ------ i �2 - _ Date ------- Final Inspection by SAN JOAQUIN LOCAL HEALTH DISTRICT wk& N.F_ i E. H. 9 1-'68 Re. 5M �- ;