71-012 - Laserfiche WebLink

Home Browse Search

i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �/�1� 4 --------------------------------------------------------- Permit No- -- ------------- --(Complete in Triplicate} ------....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�CountyOurcdfinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -�- - - - t--1` ------------------CENSUS TRACT -------------------------- --- = _ Owner's Name _ � - ------- ----- =Phone ---------- ,Address.4 -2_.4r --- _ ` ------------- City --- - ------------------------------ Contrcctor's Name ------ - - ----- 1- --------------License # Phone ---------------------•----- Installation will serve: Residenc ❑ Apartment House❑ Commercial :oTrailer Court 0 Motel ❑ Other .----A -- ------ ----------------- Number of living units:__--` --- Number of bedrooms ------Garbage Grinder ------ Lot Size -----C4_-_<,A <�-�:_----_-. Water Supply: Public System and name ---------------------- ----------------------------- ---------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [9" Clay Loam ❑ r r 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 seep ge pit-permitted�if-public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size_5; i_,O--4--S---------------------- Liquid Depth Y:__--__-----•-_- I Capacity . 0-04-. type Material_ __,___ No. Compartments __r. ------ j .Distance to nearest: Well _---_ -----------------------Foundation ....../_V______-- Prop. Line ---------------------- 6 't r / LEACHING LINE [ No. of Lines -----' --------------- Length of each line-- --- - -------.------ Total Length ------ -'----.-.------.---- 1� 'D' Box -'r---- Type Filter Material ---------+--- __-'--Depth Filter Material ----I�---------------------------------•- � Distance to nearest: Well ___.___-!-�_Q_r------- Foundation -----t_0---1------------ Property Line - ----..---_-___._.--_ SEEPAGE PIT [ ] Depth --------------- Diameter ---------------- Number --------------------- ------ Rock Filled Yes ❑ No C1 0 Water Table Depth ------------------�------------ --------------Rock Size -------------------------------- Distance to nearest: Well -_-------------------------------------Foundation --------------- .... Prop. Line -..--__--_-_---_----. h REPAIR/ADDITION(Prev. Sanitation Permit# _----------- ------------------------------ Date --------.-------------.---.-.--__-) A Septic Tank {Specify Requirements) --------------------------------------------------------------- i�Raj DisposalField (Specify Requirements) ----------------'-------------------------------------------------------------------------------------------------------------------- S: ------------------------------ - -------------------------------- ------------ .i - ---------------------------------------------------- ------ (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: . , F "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 ubject to Workman's Compensation laws of California." Signed -.. - --------- - - --------------- ------'--------------------------- Owner "f----------------- Title _ ff------ .- -7� - BY ------ -- -- ------- (If other than owner) I J FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE . �_' -�------------- ----------------------------------- -------- BUILDING PERMIT ISSUED ---- --------------------------------' - -----DATE ------- ------------------------ - - ----------------------------------------------------------- ---------- ADDITIONALCOMMENTS --- --------- ---- ----------------------------------------------------------- ---------------------------------------------------- --------------------------- -------------------------------- ---------------------------------------------- ------------------------------------- ---------- - --------=------- Final Inspection by: i ----- ---- Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M.