71-888 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USI. APPLICATION FOR SANITATION PERMIT --------------------------------------------- (Complete in Triplicate) Permit No. -_7-L ---------------- 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 pp - ------------------- CENSUS TRACT __.f_Y,7 -------- Owner's NameU"- ---- ------------------------------ ---------Phone CitYAddress ��_ f � ----------- -- Contractor's Name .l ,-t � License # Installation will serve: Residence.M Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- i Number of living units:__1_------- Number of bedrooms ___3______Garbage Grinder ------------ Lot Size '__ti______________________________ Water Supply: Public System and name -------------------------------•------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt C1Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam-Od 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.) NEW INSTALLATION: (No septic flank or seepage pit permitted if public sewer is available within 200 feet,) U PACKAGE TREATMENT [ ] SEPTIC TANK�q4 Size __�_ D '� _7 �--------------- Liquid Depth -_ ��--.--- Capacity ----- Type No. Compartments __ "______________ Distance to nearest: Well 6---------------------------Foundation ------------ Prop. Line --------l______._.... i LEACHING LINE No. of Lines _,�__--_---___._____ Length of pach line--- ------------ Total Length _-aX_0?_______________ 'D' Box Type Filter Material A•f'----------Depth Filter Material __ ----/Y.-___________________________ Distance to nearest: Well ___ __________---- Foundation _Z0-- ------------- Property�Y Line Sc•---------------- .41 E SEEPAGE PIT 4[1 Depth _ ---------- Diameter _ L2_______ Number ___---__ _____,__-_-- Rock Filled Yes No - k � Water Table Depth -----PQ' Rock Size --q------------------- i ' Distance to nearest: Well /&V'--------------_------ � ---Foundation _ ------------- Prop. Line 'r-----.---------- REPAIR./ADDITION(Prev. Sanitation Permit# --------.----------------------------------- Date -----t--------------.-..----------) 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 beco Wed to W rk n's-< aws of California." �/�,�� ---------------------------- Owner Signed - u2Z ". BY ------------------------------- Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------------------- ----- DATE _11?7 •.20 _>L.------------------- BUILDING PERMIT ISSUED ----------------------------------------------------------------- •----------------DATE -------------------------------------------f, ADDITIONALCOMMENTS -------------------------------------------------------------- -------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- ----------------------------------------------------------------------- --------------------------------- -------------- ------------------------------- - ------------ --- --- ------------ ------------- --------------------- -------- -- -- Final Inspection by: = -----------------------------------------------------------------------Date ¢ Y ------ SAN —SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M