71-1129 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 7/4-2-9 ---- _ --._ -- -- ---------- - --------- -- - - (Complete in Triplicate) -- --- --^---------------------------- - --- - --------------------------------------------------- This Permit Expires 1 Year From Date Issued Date 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 ._. _�___-_, __ �P . + ---------------- ------ ---- ----------CENSUS TRACT Owner's Name ------ _�_t 1-rt�c --------F ', ;�G � Phone . gy ! f Address -------�II-0 -----� Citv Contractor's Name --- ---------------------------------License #/��-. ---_ Phone Installation will serve: ResidenceL�Apartment House-[:] Commercial [-]Trailer Court ,❑ Motel ❑ Other -------------------------------------------- Number -- ------------------------Number of living units:. - Number of bedrooms ____"____Garbage Grinder /yf----- Lot Size ._ a __ __________________ Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 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 tank or seepage pit permitted if public sewer is available within 200 feet,) \ PACKAGE TREATMENT ( ] SEPTIC TANK f ] Size---------------------------------------------_._ Liquid Depth ---_---------------------_. Capacity ____________________ Type -- ----------------- Material___ No. Compartments O Distance to nearest: Well __________________________________Foundation ---------------------- Prop. Line ___.-_________________ LEACHING LINE [ ] No. of Lines ________________________ Length of each line--------------------- ------ Total Length rG 'D' Box - --- ------ Type Filter Material ____________________Depth Filter Material --------------------____-_----_____--_.__._ Distance to nearest: Well ________________________ Foundation ------------------------ Property Line __-____._-_---__-_____ SEEPAGE PIT [ ] Depth ____________________ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No iC] Water Table Depth ------------------------------------------------Rock Size ---------------- - Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Lime ---------------------- REPAIR/ADDITION(Prey. Sanitation Permit# -------------------------------------------- Date ---------------------------------_) -�-� l� I /� • -__ Septic Tank (Specify Requirements) ---�'�-/.,�C'�/�____�t�17'� -�S. __,�JV11---�1�/.�;��=��y�D��'�_ �G z- =�_a��- 1 r 1° .c_----------- Disposal Field (Specify Requirements) _��91� ____,�9_ _ /y .' -� -----------------------------------------------------------------------------------------------------------------------------------------------------------=-------------- --------- ------------------------------------ -- -------- -------------------------- ----------------.--------------------------------------------------------------------------------------------- (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: "1 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 ---- --------- --------------------------------- Title -------- -------------------------------------------------------------- ----------------------------------------------------- --- -------- [I er t an owner) AitTMENT USE ONLY APPLICATION ACCEPTED BY ------ __, __ DATE ------ BUILDING PERMIT ISSUED ---------- ---- ------------------------------------------------------------DATE A ITIO AL COMMENTS - -------- �� ------ W-9�------ ----- ------ ---------- h' f -~ � t ,I -----{;VAe_.R------ --- ---- -- ------- -- - f - v-----y f/ --- �r-vr u �� -,_- .�,,,� -- a-- - ,�;-- ��-�->�- �--- -- - -------------- -- -- -- -- ----------- al Inspection by: -- - -------- ------------------ ---------------------------------------------------Date USAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M