68-513 - Laserfiche WebLink

Home Browse Search

,FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------------------- ---- ------ Permit No: . _ _v_` � 3 (Complete in Triplicate) 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 with County Ordinance No. 549 and existing Rules and Regulations: ' JOB ADDRESS/LOC ON :. t CENSUS TRACT ------------------------- r 4 Owner's Name ---- -- - - ----"--- ------ ----------- ------------------------ Phone ------------------------------------ Address 1//�� -- - --- - --------------------------------------- - CitY r ""Ilx ----- --- ---- --------i---License # P hone --- --------Contractor's Name j Installation will serve: Residence Apartment House❑ Commercial:ElTrailer Court 1❑ Motel ❑ Other ------------------------------------------- Number.of living units:-- ------- Number of bedrooms ---------Garbage Grinder - - Lot Size -- ---------- Water Supply: Public System and name ---------------------------------- ---------------------------------------------------------------------------Private�J { Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -OM Clay Loam ❑ Hardpan 0 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,) I/ r ! - Liquid Depth -4-------- ------------ PACKAGE TREATMENT [ ] SEPTIC TANK' Size�°�t_�_�__-�----,--"--- - - q P Capacity ----rf_�___a__: _ Type _______ j___ . __ Material ��-=g___ No. Compartments .11- �._.._:____ Distance to neares Vl/ell Sfl____________________Foundation ____.�_�Gi__�_-_---- Prop. Line ___. _______.._.__ LEACHING LINE [ No. of Lines -----Z--------s -_ LeA , each lline---S/S--/-----.--------- Total Length -Z_ a--------------- 'D' Box _-- Type Filter aterial ---- -,_-_ ---Depth Filter Material ....1_�----------------------t- ----•- Distance t nearest: Well '______ - @__-_ ___ Foundation -- ---- +--------- Property Line ____vS________________ SEEPAGE PIT [ ) Depth ____-_ ____ Diameter __ - _--_,___ Number _____.- - - -_ ._._______ Rock Fitted Yes ❑ No I❑ Water Table Depth -----------_ 4 T Distance to nearest: Well -------------------------_______________--Foundation _.__ ._____----_____ Prop. Line _________ ............ REPAIR/ADDITION(Prev. Sanitation Permit# ---------�__-_.- j---------- -------------- Date ______,______.___ ---------------- ----------------------- Septic ____________ -) Septic Tank (Specify Requirements) ------------------------------ -----------------5� �'� a#t ---- rs. La Disposal Field (Specify Requirements) -----------------------------•-------------- --------------------------------------------- / ------------------- ' P ,� --------------------------------------------------------------------------------------------------"-------------------- ------------------------------------------ ------------------ 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 Mules and Regulations of the San Joaquin-Local Health District. Home owner w licen- sed agents signature certifies the following: "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 becom A ubject to Workman's Compensation laws of California." Signed ---- ---------------------- - �� - " Owner - -- ------- - -------- - ------------------------ BY -------------- - --- ------ -+ - _-- - -- ------------------ Title (If other than owner) FOR .DEPARTMENT USE ONLY L APPLICATION ACCEPTED BY -------------- ----------------------------------- DATE ------------------- BUILDINGPERMIT ISSUED --- ----------------------------------------------------------------------- ----------------------------DATE -_--------------------------------------- ADDITIONAL COMMENTS ------------------------ ----- ---------------------------------------------- --------------------------- ---------------------- -------------------- - ----- -------------------------------- Final Inspection by: -------------------------------------------------- ---------------- ------Date ---- - ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M