71-1126 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: f�"'��' /3D—1 APPLICATION FOR SANITATION PERMIT � (Complete in Triplicate) Permit No. ----------------- ------ " This Permit Expires ] 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 .-----4? U __ ± yy� ---------------------------------- CENSUS TRACT -------------------------- Owner's Name _.`7Ll_�F- ,�[ ,!` ---------------------------- _Phone Address u-n'1---3---- ----. Cit - ------------------------------- -- Contractor's Name/ h qty C n-K----------License #4d.d'9;,S--/ Phone Installation will serve: Residence,6 Apartment House,❑ Commercial ❑Trailer.Court .:❑ Motel"❑'Other -------------------------------------------- , Number of living units:.... ---- Number of bedrooms ---- -----Garbage Grinder -:- .-- Lot Size Water Supply: Public System and name ------- -•;------------------------ __________________Private.] Character of soil to a depth of 3 feet: Sand'C] Silt Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe �k Fill Material ------ ----- If yes, type _____________j (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 TREATMENTV L l SEPTIC TANK'[ l Size -------------------- --------- Liquid Depth --------------------- Capacity -------------------- Type -------------------- Material---------------------- No. Compartments ------------ Distance to nearest: Well -------------------------- -______-Foundation _____________________ prop. Line __.---______.:__._____ LEACHING LINE j No. of Lines ----- l------------ Length of each line------/�-e f Total Length ---- - ------- 'D' Box - .--.__ Type Filter Material ----- ......Depth Filter Material --------/t Distance 48�•nea_rest: Well Foundation .__-_ - __--:- Property Line ��----r-- ---------- SEEPAGE PIT DepthNumberDiameter _ _ __%� ------- ___________ __ Rock Filled Yes [� No 0 � -------------------- Water Table Depth ---------- = ----------------------------Rock Size --------- `' Distance to nearest: Well ------� ____-------------------Foundation ----J_ ------- Prop. Line ...... REPAIRTION rev. Sanitation Permit r# --------------------------- ---------------- Date ----------------------- ) Septic Tank(Specify Requirements) ______________________________________---_----__-------- Disposal Field (Specify Requirements) ----------------------- -- �-------- -------- ---------------------- - li _ = - (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be dome 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 wner - ------- ------------------ ------------ BY ---- �� ------ -Title ----- - ------ ------------------------------- other than owner) . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -_-�- - --- ------- --------------------- ------------------------------------------ DATE ..../r� .. 7/ BUILDING PERMIT ISSUED ----------------- --- - - ---- ------------ ------------- ---�------- ----- ------------ ----------DATE -.------------ -- ------------------- -- -- ADDITIONAL COMMENTS ---------p a `r --------------------------------------------------------- ---------------K--- --=-----J-----------------------------------•-_-_-_--------_- --------------------------------------------------------------------------- ----------- -------------------------------------- ---- ---- ------ - ---- ----------------------------------------------------------------------------------------------------------- ----- -------------- ------------------- -- -- ---- - t - - -------Final Inspection b j -------- ---------------------------------------------------------------- -------------/1--- ------T f - -----------Date - .7/ -- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 7-'68 Rev. 5M