71-174 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - ------------------------------------------------------ 1--�_!11------ 10,30 fl- rfv\ ----- APPLICATION FOZ SANITATION PERMIT „ . (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Permit No. 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: _CENSUS TRACT JOB ADDRESS/LOCATION .------�---------1'---------------------`------------ ----------------------- -----------------•---•--•- Owner's Named ' f `r, zi ' ---------- -------Phone --6-•--�=------ Address City Contractor's Name ------------ -------------------------- ------.License # ----- --- ------ Phone ---------------------- ------ Installation will serve: Residence artment House❑ Commercial :❑Trailer Court ;❑ Motel ❑ Other / Number of living units: --- /------ Number of bedrooms / .Garbage Grinder A' ! --- Lot Size _t- ___ l Water Supply: Public System and name_ -__-__1P- -------------------------------------- Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam .❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ 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 seenage pit permitted if ublic sewer is ovailak�le within 200 feet, PACKAGE TREATMENT { ] SEPTIC TANK Size____ -----------------�___� �� ------ Liquid Depth _.41'� ----_---____________ Capacity `s— ',' F; TYPe � '�,''~�`�'--- Material---------------------- No. Compartments. ------............... Distance to nearest: Well ------------------------------------ Foundation { _---------_-_________ Prop. Line -______F:______..___ J LEACHING LINE fi No. of Lines ---- /_____________ Length of each line-_�P. "f y ------ --�-- Total Length ��'-'-------------------- 'D' Box ------------ Type f=ilter Material ____________________Depth Filter Material -------------------------- ----------- V1 Distance to nearest: Well _______________________ Foundation ------------------------ Property Line ___________ _- ---- SEEPAGE PIT Depth c / is p_rDiameter_ Number — --------- Rock Filled Yes No ❑� ---------- Water Table Depth ------------------------------------------------Rock Size____ _ __.__.____- Distance to nearest: Well _' _____________________ %r�_____________ ______Foundation ._____ Prop. Line___________________ °�• REPAIR/ADDITION (Prev. Sanitation Permit #-------------------------------------------- Date --------------.__--------------•-_) Septic Tank (Specify Requirements) -------------------------------------------------------------------------------= Disposal Field (Specify Requirements)---------------------------•-------------------------------------------------------------------------------------------------------- - -------------------------------------------------I---------------------------------- (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-------- ------------------- ---------------------- -- ------ Title ------ -------- ---- ---------------------------------------------------- (If other than owner) FOR DEPARTMENT APPLICATION ACCEPTED BY -.le,Z-__�-- BUILDING PERMIT ISSUED ONLY ------------------------------ DATE DATE - ---------------------- -------------------------------------- ADDITIONAL CO ENTS .. - - -------------------------------------------------------------------------------- --------------------------------------------------- ------ - --------------------------------------------------------------------------------------------- ------------------------------- ---- Final Inspection by: ----- ------------- -----------Date -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ---------------------------------------- ----------------------------------------- -----------------------------------------