71-1173 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT N -� ------•-n----- - --------------------- Permit o. r--------••------ � [Complete in Triplicate) .,� s Date Issued _� =_Z�= • This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Loca'I..Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 5 9 and-existing Rules and Regulations: I JOB ADDRESS/LOCATIO /Wo2 ------CENSUS TRACT ------ J--------------------- I - -- ---•---- Owners Name Y • ----- ----- Phon CitY �� Address ------------------ f - ---- Contractor'sName --------- - 'L�✓ --.License #laU- //------- Phone T- -. - --- Installation will serve: Residence XApartment House❑ Commercial :❑Trailer Court ;[] !! Motel ❑ Other -------------------------------------- --- s Number of living units:------!_--- Number of bedrooms �1'--____Garbage Grinder ------------ Lot Size _/S_Q-x7s �` -;urate-CSupplyYPublic"System and'name -- - '-- �� Private-[� �- •- - k ElClay E] Reat'❑ . Sandy Loom -C] Clay Loam ElCharacter of soil to a depth of 3 feet: Sand'❑ Silt '* `1 ±Hardpan ❑ f. Adobe Q Fill Material =4y - pe_ ---------------- -- (Plot plan, showing size'of lot, location of system inI relation to wells, buildings,•etc.must be placed on reverse side.)- F NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ._,,,.r..,...� •.•---• Jnr PACKAGE TREATMENT_-.[.,.I SEPTIC=TANK ( ]� Size___-_---------- --------------------------- Liquid Depth ------ q p -------------- �• t Capacityi��`=---------- Type --- Material_�_�__ -------=-No. Compartments -----------•-•----•--- 01. _ ny <- _ %Foundation Pro Line Dis#ante to nearest: Well -___________________ ________�_.. p• ` Total" Length ---------------------------- LEACHING LINE �[.]i No. of Lines ---------'------------ Lengtt of each ELine:".----- -------------- 9 D' Box ----------- Type Filter Mat-,erial# _.' --------------Depth Filter Material --- -------------- - „ ia Distance to nearer% ell _- - -,-':- _ Foundation _____ _________________ Property Line _____. ______...---:- Distanc _-- f SEEPAGE PIT [ Depth" RiamefierNumber _._ -.__._- Rock[Filled Yes E3 No I❑" fi i --.I,. lr I > i ~,-----------------Rock,5ize --------- r Water�Tabfe Depth ' Distarice �o-nearest�y W�el�l�--�'--�'�--- ^-;j-------�_�Datendationw--------�--------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit#� } . - ` ' ---• --------------------------- Septic Tank (Specify Requirements) __---_.____---_- --- - F , r .'`'' /] I Disposal Field (Specify Requirements) �-C L Q --- --------------s_ ---------------- --------------- - �. --- _ t_ ----- - --------------------------------------------------------------------------------------- --i---------------------------------------------------- N_ j (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 ._s County Ordinances, State�Laws, and Rules.and rRegulations of the 5brr�Jodqu.in,-Local Health District, Home owner orlicen- 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 become subject to Workman's Compensation laws of California." i I Signed --------------------- --- ---- r ------------------------------------------------- Owner BY ---- = Title --- ` ----------------- (If r than owner) _ FOR DEPARTMENT--USE-ONLY~- APPLICATION ACCEPTED BY - ---------------- DATE/2._ --------------- BUILDING PERMIT ISSUED ----------r I--------------- ---------------DATE ------------- -------- ----- ----------- ADDITIONAL COMMENTS -- -------'--------------- ----------------------------------------------- ----------- ---------- ----------------- - ----- ------------------------------------- - --- ------------------------ -------------------- ;. ' f Final inspection-by: -.e------------------- Date --------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M r'