70-112 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT i Permit No. . �-I� (Complete in Triplicate) - ------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued s 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: • r I JOB ADDRESS/LOCATION - -J-�----------------- --------------- CENSUS TRACT __ ' _ I- Owner's Name ------- ----------------------- ------..Phone -------------------- Address � 7 ��'` -------- City --- ----------------- ---------------------------- ------ Contractor's Name _____---___ - ------ --------=�---- - License #.�� Phone -------------------- --------- Installation will serve: Residence partment House-E] Commercial :❑Trailet Court i❑ Motel ❑Other - k Number of living units------ Number of bedrooms ___4l_C______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-Loam;❑ Hardpan ❑ Adobe 0 Fill Material ------ If yes, type ---------------------------- F - 4 (Pl'ot 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 [ ] SEPTIC TANK'[ ] Size------------------------'-------------_------- Liquid Depth ---------------------.___-- Capacity ---------------- --- Type -------------------- Material-----------:---------- No. Compartments ---------------------- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -----------._-_-------- V LEACHING LINE [ ] No. of Lines ------------------------ Length of each line------------------ -------- Total Length -----------------••--------- `yVl 'D' Box -------- -_- Type Filter Material --------------------Depth Filter AMaterial --.---------------------------.._..-•--,--•- V Distance to nearest: Well -______#'"""` _' Fondation .- _____.- Property Lane __ := _ th { SEEPAGE PIT Depth ___________________ Diameter ---------------- Number ------------- Rock Filled Yes .Q No C] Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ------------------------------`�---_-..Foundation ___----------------- Prop. Line --------•------.----- _ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------- '"_________________-__) Septic Tank (Specify Requirements) ----__-- ---- ------------------ ---------------------- -------- -------,---, Dis osal Field (Specify Requirements) - - ---------------------------------- - -_ - -------- --- t I C -- -- --- a -- -------------- _ (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 certify that in the performance of the work for which this.permit is issued;.) shall not employ any person in such manner as to become suble Workman's Compensation laws of California-, Signed �._ - n —0 BY ------ - -- ` -- TJ, ----------------- -------- ------- ---- --------------- (If other than owner) FOR .DEPARTMEN USE ONLY APPLICATION ACCEPTED BY - ADDITIONAL COMMENTSDATE/ -' BUILDING PERMIT ISSUED 5-=-------------------- ----------------- - DATE ------------------------ -------------------- -------------------------------------- ------------------------ -------------- / ------------------- - - -- ---------------------- --- ----- --- -------------------------- �--------------------------- - ---------------------------------------- --------------------------------- - T-------------------------------------------------- =-- --------------------------------------------- Final Inspection by: _. .'%-?- s,.e%.----- --------------------------------Dater -Xj----- ------------_----- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E- H. 9 1-'68 Rev. 5M