73-513 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --,-- Permit No. ---------------- (Complete in Triplicate) Date Issued ___. 9"�3 ----- This Permit Expires 1 Year From Date Issued -- Application is hereby made to the San Joaquin Local Health District for a per 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 __ _ ' _____ 'f_ -------------------------------------------CENSUS TRACT ___ _ -_-- Owner's Name IZf.?_tZ E� - Phone ,, �� Address 7 d � -------------- city i If -----------------------.---- - 4 Contractor's Name ___65�,)r_--- -------------------------------------------License Phone ' s Installation will will serve: Residence ([Apartment House❑ Commercial :❑Trailer Court Motel ❑ Other -------------------------------------------- Number of living units:_-___ ___ Number of bedrooms ___Sa_--__Garbage Grinder ___________ Lot Size __�j___�aelev�,_________________ Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ 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 sew r is available withi 00 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK T ] Size------------------- --------------------------- L' uid Depth --------________-___------ Capacity -------------------- Type -------------------- Mated ------- --- No Compartments ------------•----- Distance to nearest: Well ---------------------------- -------Foundation ----- --------------- Prop. Line ------ ---------- LEACHING LINE [ ] No. of Lines _ _________ Length of e h line------------------- ------- Total Length ____________________________ 'D' Box ------------ Type Filter Material --- ----------------Depth Fil r Material ---------------------------------------.---- Distance to nearest: Well _________________ ______ Foundation ___ ___________________ Property Line _________.________---___ SEEPAGE PIT [ ] Depth ___________________ Diameter ___ ____________ Number -- ------------------------ Rock Filled Yes ❑ No 0 Water Table Depth ---------------- ------------------------------Rock Size ----------------------- -------- Distance to nearest: Well --- -----------------------------------Foundation -.-------- ------ Prop. Line ----------------_---- REPAIR/ADDITION(Prev. Sanitation Permit=# ------ ________________________ _ Date __________________________________) Septic Tank (Specify Requirements) -------------- -------- - ----- ------------------ ------------- � ------------------------ Disposal Field (Specify Requirements) _ �� s4�_f_Z ___ ___4'� __clG___ _., fZ --------- ��✓�,,�r��1 ,��-� eL- •�'r ��Cl �D �r��r✓ �o_��'�_ ;� .�.�� G'i-Jl ----------------------------------------------- - -- - ------------------------------------------------------------- (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, 1 shall not employ any person in such manner as to become subject to W kman's Compensation laws of California." Signed ------------------ ----- ---------------------------- Owner --- --------- BY ------- -- Title -- --------- --- ------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------/- /3-a-•------------------------------------------------------------------------- DATE ...... � ,�------- BUILDING PERMIT ISSUED ---------------------------------------------------- ----DATE ------------------ ADDITIONALCOMMENTS ---------------- ------------------------------------------------------------ --------------------------- --------------------- ----------- --------------- -- ---------------------------------------- --- -- ------ ---------- ----------------------------- -------------------------- t-------------------------------------------------- ---------------- ------------------------ - --- ------------------------------------------------ ---------- - ---- - -- - - Final Inspection Date _-- :__-"-- -------_-__-- -�--- ---- ---- ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M