73-991 - Laserfiche WebLink

Home Browse Search

` FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: -- ----_1----/:_6: {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/LOCATION f ------- ------- T --�--------------------- -----CENSUS TRACT Owner's Name ------ hlQ-___-- -------------Phone..- --�_ Address -, ld City ---- -- r�z � - __--------------- Contractor's Name .__ _ __ -- ��;-_ - _ _-_-License # __ 3___ Phone Installation will serve: Residence XApartment House❑ Commercial []Trailer Court ❑ Motel 0 Other ---- == Number of living units.---/------ Number of bedrooms ----Z___Garbage Grinder W--t---- Lot Size 61--k--gQ-`---_-__- cater Suppl�Pubrc ys em and name __________________ ___ Private ❑ Character a soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam [� Hardpan ❑ Adobbejj�_ 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,} PACKAGE TREATMENT ' [ ] SEPTIG;TANK'[ 7 Size ---------------- � - ------ Liquid Depth - ----------------- - - Capacity `' - P y ---------------- Type-------------------- Materiakt---_----------__ No. Compartments 1 Distance to nearest:` Well ----_ _Foundation -------------------- Prop. Line ______________________� { LEACHING LINE [ J No. of Lines ------'"-- ------------- Length of each line.------------------------- Total Length - -- -.....DO 'D' Box ___.-------- Type Filter Material --------------------Depth Filter' Material ----------------- N ---------- ---------------- I Distance to nearest; Well ------------- ___ Foundation ------------- Property-Line _- SEEPAGE PIT [ ] --- - Depth _______- Diameter __11� ______________ Number Rock Filled Yes ❑ No .Q P Water Table Depth ----------------------- - --------- ----=--•-----Rock Size -------------------- ` ---- Distonce,to nearest: Well ------------------ — --__•--_--------.Foundation -------------------- Prop. Line ---------------------- 0 ---------.----- -- - REPAIR/ADDITION(Prev. Sanitation Permit # __________________._._________- 0 } ------- Date ------------------ 1 Septic Tank (Specify Requirement s) ----------_----------------- . Disposal Field (Specify Requirements) ---1A,7._ - " ------------ ------------------------ ----- ------------------------------------------------------------ ---------------------------------------- ----------------------------- ------------------------------------------------ ---------- ---- --------- - - ------------------------------------------------ ------ -- (Draw existing and required addition on reverse side) t 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: i "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 -----------------Irt Owner. By ------------ ------- Title (Ifo n r} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE a 2 BUILDING PERMIT ISSUED --- DATE - -"----------------------AL COMMENTS -------------------- -----------------------------------------=--------------------------- --- ---- ----------------------- ------------- ----------- -- ---- ---- ------- --- --- - --- - - ----------- - ----------------------------------------------------------------------------------------------------- ------ ------ ---------------- --- -------- --------- Final Inspection by: -------------Datee - -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M