72-923 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------- Permit No. r (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 ---- _ K_exis_:-- ---------------- ----CENSUS TRACT -- ------------------------ Owner's Name -------/� -- ----------- -------------------Phone ' 7 ` ----------------- -------------- Address --------- ------------- n -----------. City /f ter---- Contractor's Name _. _ _ __ _. 3.4_ ,___ . �c'!-��Y %-z-c '___-License # �_�_7_ Phone tr-. _.Z_-yf,1` . Installation will serve: Residence 7 Apartment House'C] Commercial []Trailer Court ',❑ Motel ❑Other ------------------------ ---- Number offhving units:-----f----- Number of bedrooms _________Garbage Grinder ------------ Lot Size ___ __ r .t�________________ Water SupplY:.Public System and name V------------•--------------------------------------------------------------------------PrivateA Character of soil to a depth of 3 feet: Sand❑ Silt•o — Clay ❑-- Peat= Sandy Loam;& Clay Loam ❑ Hardpan ❑ Adobe ❑ FilfJMaterial 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 [ I SEPTIC TANK'[ J Size_________________________________________ _____ Liquid Depth . ----------------_--------- Capacity ___,____ Ca acitY ____ Type No. Compartments ` .----- .._...:..-. 61 Distance to nearest: Well _______/G __ - ____--__Foundation ...6--"Z Prop..Line .-_.-_�.:_......_ V ' � o LEACHING LINE [ ] No. of Lines _.___.3-------------- Length of each line_-______/_�_"___._-___ Total Length: ,_- -3- _G......._... 'D' Box ____ Type Filter Material __1 -3- _41%_ I-- Material ----tJY_______________________________ Distance to nearest: Well ____L A-9___=_-,__ Foundation ------/-A------------ Property Line ____��""__..__._.... SEEPAGE PIT [ ] Depth ______________ _____ Diameter ---------------- Number ___._.___ ----------------- Rock Filled Yes ❑ No Water Table Depth ---------------------------•-,------------------Rock Size ----------------- -------------- Distance to nearest: Well ------------------------ ---------------Foundation -------------------- Prop. Line _____________:________ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________._______) 3 Septic Tank (Specify Requirements) ------=--------------------------------- ----------- --------------- ----------------------,-------------- --;.---------------------------- N DisposalField (Specify Requirements) -----------------------------------------------------------=----------------------- ------------------------------- --------------- ---------------------- ---------- - -------------------------------------------------------------------- ------------------------------ - (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and thdt,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 certify that in the performance of the work for which this piarmit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---------------------- Owner --------------------------------------------------- er BY ` /j ' -------- ----- ------ Title- -------- - --- ------ --------------------- (If other, tan o ned FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ `" DATE _..�. r BUILDING ..PERMIT ISSUED ._ "_ - --------------------DATE ---- ------------ ADDITIONAL COMMENTS ---------------- - -- --- ------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------- I---------------------------------------------- ------------------------------------------------=-------- Final inspection by. ------------ --------=----------------- ---- - Date y `' j-------- I SAN JOAQUIN LOCAL HEALTH DISTRICT F. H. 9 1-'68 Rev. 5M