73-242 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------- -------------------------------- - P (Complete in Triplicate} Permit No. 2- .....----- ------------ - ---------------- - ____-._-_._ This Permit Expires 1 Year From Date Issued Date Issued - --------— f 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 C -- ---- - CENSUS TRACT -------------------------- Owner's Name - ;----- -- Phone � ----------------- Address ----------- - Cit � 1r, _ Y -------------•----------------- n Contractor's Name ____-___ -' w -___ -J- -- _~__ _ ------License #� _ _ Phone ________________ Installation will serve: Residence - Apartment House�❑ Commercial ❑Trailer Court ;❑ Motel E]Othe --------------------- ----------------- Number of living units_____________ Number of bedrooms _ '��-_-Garbage Grinder ------------ Lot Size ____ - � --__ Water Supply: Public System and name ____________________ - _..Private - ..-------------------------------------------------------------- - Character of soil to a depth of 3 feet: Sand❑ Silt❑ -Clay ❑ Peat❑ Sandy Loam f Clay Loam ❑ Hardpan [) Adobe ❑ Fill Material_____________ If yes, type ---------------------------- (Plot _--_.__.----______-__ _(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) Q 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 "_______________________Foundation ---------------------- Prop. Line --------__-_ LEACHING LINE [ ] No. of Lines ------------------ .Length of each line--------------------------- Total Length ------------- 'D' Box ____________ Type Filter Material_.-------.-----------Depth Filter Material ___-_-__-____- ----------------------------- - Distance to nearest: Well _______________________ Foundation ----- ------------------ Property Line SEEPAGE PIT ( ] Depth -------------------- Diameter' __:'*`---------- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth - <.------.._1-----�Rock Size __ Distance to nearest: Well ------------------------------ -----1- Foundation ---------------.---- Prop. Line ----__.------------ REPAIR/ADDITION(Prev. Sanitation Permit# ___________________ __-_--___'Date _--________--____ Septic Tank (Specify Requirements( ________.___-____----------- ---------------------- - - x ____ . " -- -- --------------------- Disposal Field (Specify Requirements). .: fie_" : ---- `--------------- -------------- ---------'-----Y 2---`- -- ----------- I �` ---------------------- -------------------------------------------------------=----------------- -- (Draw existing and required addition on reverse side) I hereby certify_.that.l 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-�.� ".` '- `'w "1 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 Workman' -Co pensation-•laws-of California.-" ---- -- ---� -• --.- Signed ---------- ------------- - ------------ -8vvner BY ------------------- Title •L--e'`$ ---------- ------------------- - (If other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --��-' -- --- --------- - - ------------------------------------------ BUILDING PERMIT ISSUED _______________________ ------ ------------- -------------- ----'------ -------- -------------- - ------DATE -- - --------------------------...__._ ADDITIONAL COMMENTS ------------------------------------- --- -- -- ------- ------------ ----------------------------------------------- ------------------- - --------------- � . Final Inspection by: ---_ _ T -- Date 1 - ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ,�