71-613 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �f t r I - ----------------- ----=------ -------------- Permit Nolf-L.�-1-5— (Complete in Triplicate) n ---- -- ----------------------------------------- This Permit Expires 1 Year Fro 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 complianeg with'County Ordinance-No. 549 End existing-Rules and Regulations: -- -`------------------------- -----------------CENSUS TRACT --------------------- JOB ADDRESS/LOCATION ----�-/ __ / Owner's Name - ----------- ` = ----------- hone Address ----------- d ->r� lG_�11_ , fCity . ' j J / ------ --- ------.License # --� �------ on ��_�`. Contractor's Name Installation will serve: Residence ❑Apartment House❑ Commercial :❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:________ Number o Brooms Garbage Grinder..,15/q___ Lot Size ___ --/ ---------------- Water Supply: Public System and name" __ ____-_ _ r ��_ _--_----------------- --------------------------------Private ❑ Pet Sand Loam Clay Loam Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay a ❑ y ❑ y ❑ Hardpan ❑ Adobe Fill Material "y - 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: Size--�� ~ ------ --=------- Liquid Depth � __---------- Capacity .-_._____ C Ca acit / __:________ Typei� -!_� Material_ No. Compartments p Y Distance to nearest: Well ------------- __________________Foundation _. /?.---________ Prop. Line .------------------ 4F LEACHING LINE [ No. of Lines ------------------- Length of each line. d--------------- Total Length/ 4'___________________ 'D' Box -_l1Ld__ Type Filter Material [/�= --/paCkpth Filter Material ___ _____---------------------------- Distance _________ ______________Distance to nearest: Well __.______-- ---_____'_ Foundation __`C'_./-_-__.--. Property Line_____________________ SEEPAGE PIT [ Depth _��_/-_._ Diameet/ter, ! Number ------�-------.__.______ Rock Filled Yes [�o >D Water Table Depth --------rP---rJ (----- , ,-------------Rock Size ---/�---------------------- Distance ---�--f--------- Distance to nearest: Welt -------------------------_--------------Foundation -----l d.----._ Prop. Line—S`-_---___._.......__ REPAIR/ADDITION(Prev. Sanitation Permit#'-.-------------—--------------------------- Date ----_______________.______________) SepticTank (Specify Requirements) -------- --------------------------------------------------------------- ------------------- -------------- -------------------------------- Disposal Field (Specify Requirements) ------------------------------••--------------------------------------------------------------= _ _ d""^"'�* 4 ________________________________________________________________________________________ _ ___._____y ____a____________________________________________________ 3 -------------_____---_________-------------_---- .-_____-__________.__. (Draw existing and required addition onEreverse side) I hereby certify that 1 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 at�.to become subject to Workman's Compensation laws of California." Signed i -------------aoth4an -------------- --- Owner Title �J ---------- ---- ---------------- BYE- -- - ----------------- (i owner) 11 FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY --------el-'.1k ------ ------------------- DATE --------(0--- ---------- BUILDING PERMIT ISSUED - _ = =" y 1 ----DATE ADDITIONAL COMMENTS ----- ----f(,�a -----t 5- �-- - - ----- ------�'co�`r-" ----------------------------------------' -- -t - ----- - - -------- ---------- -- --- I--1�=--- -~--�__------:-`----------------- --- ---------- ----------------------- ----------------------------------- -------------- ---------- - ---- -v- I ---------- ------------------------------------ ---- - - - --- - - - -------------'---- -- - -- Final Inspection by ----------- Date/ --------------- ---- Final -- ®-- - -- - ------- - SAN _AQUIN ,LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M