72-745 - Laserfiche WebLink

Home Browse Search

—.FOR OFFICE USE: APPLICATION fOR_ SANITATION PERMIT (Complete in Triplicate) Permit No. --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ._. _ �y 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 . --------/-�'----- .._Aa_4' -------------------CENSUS TRACT -------------------------- Owner's Name ----__-.. 1 -_----___�I_--� ^.-___-f_4-__- ----_�-_---------------------------- ----------Phone -it- .--�-�__3.._. Address -------------------- c�'et�t'y . City ®. ----------------------- ------ --------- Contractor's Name -------- Contractor shame --- j. --------- ---------------------------------------------License # � �1-------- Phone _ix-�_P __ Installation will serve: Residence Apartment House[] Commercial :❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- 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 ❑ Clay Loaml:] Hardpan ❑ Adobe 19 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.) ` NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,} V i� LM PACKAGE TREATMENT [ I SEPTIC TANKSeize___-_25_--___________________------- Liquid Depth ----, ------------ Ca _--.. Capacity�� ._-- f Type ��'-��'-_____ Material_ ____-_ No. Compartments __ .--....... 0% � _ ` ! Distance to nearest: Well ____________________________________Foundation -__ ___________ Prop. Line ---_. -----_____-_41" LEACHING LINE No. of Lines ------.�._____________ Length of each line-----�_.�'�__------------ Total Length s� 'D' Box ______---Type Filter Material --______Depth Filter Material _______f '.......................... � - ---------_------ SEEPAGE 1 , Distance to nearest: Well ____________-_-________ Foundation .../0-------------- Property Line ___fir_ ________._/ r� SEEPAGE PIT �Cj Depth _41-46____-___ Diameter __� _____ Number -- ------ --__ Rock Filled Yes No ''// /� Water Table Depth ------------------------------------------•-•---Rock Size �13- �? Distance to nearest-. Well --------------------,-------------------Foundation -v__` `.---- Prop. Line _..-_-__--.-- REPAIR/ADDITION(Prev. Sanitation Permit# --------------____ _____) --------------------- Date ----------------------------- SepticTank (Specify Requirements) ---- ----------------------------------------------------------------------------------------:--------------------------------------------•- DisposalField (Specify Requirements) ----------- ----------------------------------------------------------------------------------------------------------------- -- --------------------------------------------------------------------------------------------------------------------------------- ------------------------------- - - (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 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 permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---------------------------- ----- --------- -------- --------------------------------------- Owner BY - --------------- `----- . --- - ---------------- (If other t a owner ------------------ Tit a ._____.____ e_ DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ----- - - -- --------------------------------------------------- DATE,- �f` ---------------- BUILDING PERMIT ISSUI D . ---- --- DATE ADDITIONAL COMMENTS ------------ ------------ ------------- -------------------------------- -- ------------ --------------- ------------_---------_------------------------------------- ----------------------------- - --- - ---- ----------------- ---- ----- ---------------------------- i -- - - ------ Final Inspection by --------------Date . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,