70-153 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: `l APPLICATION FOR SANITATION PERMIT \ ----------------------------------------- (Complete in Triplicate) Permit No. I 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 wit County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT N: JJ - -----�`�-.------1 it-..CENSUS TRACT Owner's Name ---------- Phone + Address --------- ------------ ------ -- Zity ----- f ------ Contractor's Name -__--- --- icense #1��317 Phone _ Installation wilt-serve: Residence partment House Commercial ❑Traile�;Court !❑ Motel ❑Other ----- Number ---Number of living runits:----- ----- Number of bedrooms _y____Garbage Grinder ------------ Lot Size ".Qc'' !! _iWater :5upply:_Public System and name ____________-_ -"""Private __ ---------- ---------------------------------------- ------------ of soil to a cl pN of 3 feet: Sand;'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ,Clay Loam ❑ Hardpan [] Adobe'D Fill Material ------------ If yes, type -----__ (PI'ot plan, showing size of. lot, location of7system 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[ ] Size------------------------------------------------ Liquid Depth ______ --------------•---- Capacity - - ---------------- Type -------------------- Material-------- ------------- No. Compartments --- Distance to nearest: Well ---------- J-------------------------Foundation ---.-------------------- Prop. Line -_-----•-.---------.-_ LEACHING LINE [ ] No. of Lines ------------------------ Length of eachline_-------------------------- .Tota! Length _----______ 'D' Box ___ -------- Type Filter Material ___________________Depth-•Fitter •Material -----_______.-_ _ ---------------- Distance --------------Distance to nearest: Well s _____ _______________ Foundation ------------------------ Property Line ------------------------ SEEPAGE PIT C ] Depth -------------------- Diameter - ----_--------- Number ------ -----------------I.. Rock Filled Yes ❑ No .i(] Water Table Depth ---------- ----------------------------Rock Size --- } Distance to nearest: Well .. --________________________Foundation ------------.---- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitationl Permit# -------------------F----------------------- iDate ------------------------------------ Septic -_-_--_--__-:----Se tic Tank (Specify Requirements) --- =------- -----------'------------------- " ---- Di osal Field (Specify Requir i ents) ` i I ----- - ----- ---- -- i --------- c _ -�Lr,-fr -- - ---------- 120 ------- ----- C(Draw existing and required addition on reverse side) # hereby certify that I have prepared this application and that the work will be done -in accordance with San Joaquin t 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: 6 _ "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 suble o rkman's Compen tion laws of California." 1 f ; Signed ------------------- -----------------1Owner ` - _ By -------------------- r ,t _-- -- - -- ---------- Title,--- -- ----3---- x A f (If other than owner) ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _- !? ,/- ----------------------------------- DATEa �7 � - ------------- BUILDING PERMIT ISSUED ----- �----------- - ----------DATE ADDITIONAL COMMENTS ------------------------------------------""---- _ --------------------------------------------- ---- -------------=----------------- - --------------=------ = = ------ ----------.------------- ------ ------� FinalInspection by. bate ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,