69-674 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT permit No. --------------------------------------------------------- - - (Complete in Triplicate) ---------=----------------------------------------------- Date Issued ---------------------------------- This Permit Expires 1 Year From Date Issued `� _/�� PP _ A lica tion is hereby made to the San Joaquin Local Health District for a permit to con ruct and install the work herein described. This application 4 r� d fin co 101in c�4vith u y rdina 4e �Io S49 and exiting Rules and Regulations:56` cj ��'�3,G. QJOB A©DRESS/LOCAT ON --- - �R, �5 TRACT Owner's Name ----- - - --------------------- --- :�+-� Phone3 '" Address -- - ---- 10 ` - Y -- Contractor's Name _-l, --------- -------- ------- - ~��----------.License #� � �J--------- Phone6,a__!_... Installation will serve:"' Residence []Apartment House Comm tial Trailer Court ❑ ,---7 Motel [-1Other __ --- Numbe€"of iving units: 1-- ___ -_____ Number of bedrooms _--1"Garbage Grinder ------------ Lot Size 07— ___ ------ ----- - Private l�~ Water S -.-ply: Public System and name-_----__,�__-a!`_-______.___ �. 7�� Character bf soil to a depth of 3 feet: Sdnd❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ,E] Clay Loam❑ Hardpan lAdobey 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 { ] SEPTIC TANK Siz _______________� - L_- ____-------- Liquid Depth ._.r__-_--.---- -_-- r Capacity _fOd- 1 Type _R Material----- --- -- No. Compartments -•_----- i -----•-- Distance to nearest: Well _ ___ - - --------- Prop. Line''� -'_ _..-- -`/GiID____-_-_-- _ _ Foundation -- 49--- --- LEACHING LINE [ ] No. of Lines --- .I__-__----____ Length of each line-------- Q------------- Total Length _,--- Q__.___._-. --- 'D' Box ------------ Type Filter Material011Q -----Depth Filter Material ------1'� �---- �-------------•- Distance to nearest: Well ___ ----- 0------------- Prope Lind`"""`"_____ -.-- �'W-r_�ii� __ Foundation p - - - SEEPAGE PIT [ ] Depth _.__/ __ ___ Diameter .S-__-____ Number ____r___�r_ RnccFilled ,Yep No Water Table Depth ------------------------------------------------Rock Size Distance to nearest: Well 0rV4-r_1CV............_-.......Foundation _____/- ____Prod=Line ______________________ REPAIR/ADDITION(Prev. Sanitation Date ------------------------------ Septic ___________________________`Septic Tank (Specify Requirements) -------------------- ' {{-- ----- --------•_--------------------------- Disposal Field (Specify Requirements) --_______ ------- V ------ ----------- W '. _I ------- ---------- ------ --------- -------------------------------- ------------------------------------------- --------- -------------------- � a --------*---� _ • 4My � (Draw existing andequired aifdition on reverse side) I hereby certif}?thai e have prepiFrecT this'applicafioi; ori hlof-the work will be done in accordance with San Joaquin County Ordinances, State laws, and Rule `add 1169 ;5tions 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 th.i.s permit is issued, I shall not employ any person in such manner o as to become subject to Workman's Compensation laws of California." Signed - - - ---------------- ------------ - ---------- Owner -- ----------- --------- ---------- 4 BY ------------------------------ --f------ -- --------------- ------------- Title -------- ) (If of than owner) ENT USE ONLY / APPLICATION ACCEPTED BY ---------------- - ----- -- ----- --------------------------------------------- DATE - --------- BUILDING PERMIT ISSUED ;w - -- ----------------------------------------------- DATE - ---------------- ADDITION L . MMENTS ___________�._ -- �- 7 A/i "- '- + -------------- ----- ------------- -------------------------------- ---------- - ----------------------- ------------------- ----------------------- I---- - ------- ------ ------------ ----------------------- - ------ ---------- ----------------------------- ----z�---- Final Inspection by: -------- - -- - - • .-------------- '-----------------------------------------------------------Date _� . - �- ----------- ' �JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M