71-396 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR"SANITATION PERMIT ------------ Permit No. . -------- (Complete in Triplicate) ------------------------------------------- t ________ This Permit Expires 4 Year From Date Issued Date Issued - �3S_ 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: k -�- JOB"Aa R SS/Lo�ION ------ _i?- ?Me - ' �� -- ��- ��-�---=`-----��-%II10Ei�US RACT ---------- { - G ----------- � '-�`!�` V-.7 ----- 1 - %�C/ .C` J PT o _U r�`-c - �-o Owner's Name �i Address -- AL --- - ----------- ----- Ity ! - -------------- Contractor's Name -- ---,----�, o /-----------------------------------#---(License # _ � _ Phone Installation will serve: Residence C]Apartment House�21 Commercial:❑Trailer Court ;❑ r Motel ❑Other ' ,. Number of living units-------------- Number of bedrooms _________Garbage Grinder __________ Lot Size /M-a&&ar-------------- Water Supply: Public System and name -------------------------------------------+-- :-------------------------------------------------------------Private ❑ Character.of soil to a depth of 3 feet: Sand]. .. Sift[] Gay ❑# 'Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe ❑ Fill Materia] -- 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,) ZY PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size_-t'_Q�_ � _ �_._ ______ Liquid Depth __ - Capacity Type n-r us+�t . (J ei f -------,��-----=---- - atenal-_ No. CoCom artments Distance to nearest: Well ------ _ _____-_-_ Prop. Line ___•-----•---_-------- rn -- - -- ---- ------Foundation -�--------- � f LEACHING LINE { ] No, of lines -----%---------------- Length of each line_______/?-4�----------- r� Total Length -------------- 'D' Box --------- --- Type Filter Material Ja-Of'4------Depth Filter Material ----- Q ______________ . Distance to nearest: Well ------CIZ--__'- Foundation ______________ Property-Line` SEEPAGE PIT [ ] Depth ___ ___________ ___ Diameter,-_______-____--__ ._____.__________________-_- '❑ No �❑ f Number Rock Filled Yes Water Table Depth --------------------------------------------- --------- -" - ----------------------�--Rock Size -------------------------------- Distance - - ----------------------- Distance to nearest: Well -------------------------------------`Foundation -------------------- Prop. Line ---------------------- I REPAIR/ADDITION(Prev. Sanitation Permit=# _______-.____-------________________________ Date ---------------------------------- I + of Septic' Tank (Specify Requirements) -------------- DisposalField (Specify Requirements) ------------------------------- --------------------- ------------------------------------------------------------------------------- ------ ------- ---- ---- --------------------- -- - --- - ------------- ----------------- --- —71 [Draw existing and required addition on reverse s i d e I 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: j "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 = w = Owner BY --------------- ----- -- ---1- ----- -----�-� ---------- -------� - ------------ Title - ------------------------------------ ----------------------- (If other than owner] FOR .DEPARTMENT U E QKY f APPLICATION ACCEPTED BY ------ i f --'-1- P -- ---------------------- ------DATE ------------------------ ------------------- ADDITIONAL COMMENTSDATE BUILDING PERMIT ISSUED ----------- --------- -- ------------- -------------- --- - - - - -- ---------------------------------------------------------------------------- =-------- ------------ - ------------------------------ _ _ _ Final Inspection by: ------------------------------------------ - -------.Date ��= ----------- ------------------- --- SAN JOAQUIN LOCAL HEALTHaTRICT E. H. 9 1-'68 Rev. 5M L ;