69-28 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE � ' / APPLICATION FOR SANITATION PERMIT Y_�C� _ Permit No: - p Trip is(Complete in Tri trate ► --------------- --- ------- ----------- ------ - ------- Date Issued - ---------------------------------- ----------- F This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a per to construct and 'iristall the work herein described. This application is made+in compliance with County Ordinance No. 549 annd�%existing�Ruue's and -Regulations- t � ENSUS TRACT -----._-_ TION -------- ' - ------ JOB ADDRESS/LOCA Owner's Name /" �-'_ -- --- --- ------ • �-------Phone . ,---Address-__:_-_- -- ✓ �p '"""" _ ." C•ty ----- ='y - p _� f�Q ► Contractor's Name -------------�- --- c) ��-t/� =-------License # ------- -:- --------- Phone Installation will serve: Residence XApartment House,M Commercial ;❑Trailer Court i❑ { Mofie! F1 Other ---- ---------- ------------- ----•----- � �y_,, _ // -------- } Number of living units:-- I_____ Number of bedrooms ...... -_Garbage Grinder ---_____.__ Lot Size -___--___ --- - i30Water Supply: Public System and name ---------------------- ------------------ er---- f Private El Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Pea i.❑ Sandy Loam ,❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material - -__- -- If yes,type --..1 .- -____-______,- -- f i \ `6 °A- (Plot plan, showing size of lot, location of system in relation to wells, b Edi ngs, .etc. must ber placed on reverse side.) �. NEW INSTALLATION: (No septic tank or seepage pit permitted if public•sew r is available within 200 feet,) ` \PACKAGE TREATMENT ] ] SEPTIC TANK:[ ] Size-------------------- -—_�-�� Liquid�id .Depth ---------------- • I �. Capacity Type -------------------- Material----------------\--- No. Compartments __ ------------ Distance to nearest: Well ------------------------------------Foundation \____-----------�__ Prop. Line --------- _5,-'---_ l Length of�eac ,.line----------------------\ Total Length ------•--- - - LEACHING LINT= [ ] No. of Lines ______________-- � � , i 'Ir D' Box ---i------- Type Filter Material I' ,___-01- --Depth Filter Material --------------=4-----•--------------. - . ' ti.tti Distance-to-•nearest:-Well ---------------------- Foundation .. -- -•----�-_Property�Linel�---------••••---•-._.. Rock Filled Yes No (] SEEPAGE PIT [ ] Depth -- ------ ------ Diameter Number' --- ` x ❑ Wate Table Depth ---. Rool Size ------- =--d Jan -------------- 1 Foundation]__------ - Prop; Line __--- Distance to nearest: Well --------------------------------------- Date I r ff y. ' REPAIR/ADDITIO '(Prey. Sanitation Permit# ------ -------'----�-------'---_i--) septic Tank (Specify`Requirements) _______---- -- --- - - -- - - Disposal Field (Specify Requirements) ---------`"' _=-- ------ --= -- ------ --- ---------------- -------- ------ I------------ - �-.., -------------------------------------- 1 -I -i--------- ------------------------ ------------------------------------- - t (Draw existing and required addition on reverse side) I I hi reby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coenty Ordinances, State Laws, and ,Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sedl agents signature ce6ifies the following: "I certify that in the performance of the work for which this permit is issued, I shall notemploy any person in such manner as to become subject to_ Workman s C-ompensation-laws-of•-California.-" --- - — - I - A- Owner Signed -------------------- Title ' (if other th wner) a FOR DEPARTMENT USE ONLY E I DATE --�/cS-- -------- APPLICATION ACCEPTED BY _-. -- -- -�-- -- --- BUILDING PERMIT--ISSUED --- _ �.._ ,. , -- _ DATE ..------------------------- ADDITIONAL COMMENTS -------------------- = --------------------------•------------------------------------------ t v ti t - --- V - -----•------------------- ---------- ------------------ ----------------- ------- ------------------------------------------ -------=------------------------------ ----------------- Final Inspection b r - . - -- ----------- - Y: --------------------- - -�-- T .Date'--- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M•