68-1088 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SAM PERMIT �f 1441 --------,•------ ----------- - Permit No. --------�-�-- (Complete in Triplicate) ----------•------------------------------------- 3%76 Date Issued -_-- This Permit Expires 1 Year From 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 complionckyith. County Ordinance No. 549 and existing Rules and Regulations: Z��l Z�l O -�----------------- JOB ADDRESS/LOCATI CENSUS TRACT Owner's Name G -------------- Phone ---------------------•---------••--- ------ ------------------ i Address - City -- Contractor's Name --------- ---- - -------- --------------.License # /''� Phone -- -- fly Installation will serve: Residence ❑ Apartment House❑-' Commercial ❑Trailer Court ;❑ Motel ❑Other --- CL-i- e-41------------ � Number of living units:___------- Number of bedrooms ______Garbage Grinder /1'V__ Lot Size __- --_------ -- d Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe Materia__ if yes,type ---------------------------- (Plot _____________________ __(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 [ SEPTIC TAN [ ] Size----- --_-S------------ Liquid Depth � — ' . opacity _I-7� ____-- Type 04°_ _ Material �l�_(�___ No. Compartments ----_____/_._.._____. Distance to nearest: Well ________��_�______________Foundation __�_d__�____-___ Prop. Line ----------------- LEACHING LINE [ No. of Lines -----/_______________ Length ofeach I' e_- �---_-____-- Total Length ____/ 6f...__-_-__ �/ I 'D' Box f-� 0___ Type Filter Material,!/�,__,�pth Filter Material ____ _�_______________1. -------- Distance to nearest: Well ___-/--o_�_________ Foundation ---� ---- --____ Property Line _-_.J`�............... SOPAGEPi; [,L Depth l Disawfer __T_ _ Number .`_-_____ --_______ Rock Filled Yes 0 .0 X C � w Water Table Depth _______�--7/------------------------------Rock Size -•----- Distance to nearest: Well _____/-_/_0.........._-----------_Foundation __1P_1______ Prop. Line _ ----------- REPAIR/ADDITION(Prev. Sanitation Permit r# -------------------------------------------- Date ----------------------------------) 4 Septic Tank (Specify Requirements) ---------------- --------------------------------------------------------------------------------------- Disposal Field (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 C - BY Q -- - -- - 1/( Jule (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- - DATE BUILDING PERMIT ISSUED TE ------------------------------------ " " ` ADDITIONAL COMMENTS � -- - '_-- -------------------------------- --------- ----------- -- - ---------- -- ----------------------------------- ------- ---- --- ------ --- Final lnsection b Date ------------ � _d ---------------------------------------------------------------------- ------------ --------- --- - ---- - ------------- p Y SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M