75-579 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ...........................................•.............. 7S= 57y ......................------..... ........................ (Complete in Triplicate) Permit Na. .................- .................................... This Permit Expires 1 Year from Date Issued Date Issued . 5.... 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 mith,Xounty Ordinance No. 549 and existing Rules and Regulations: U JOB ADDRESS/LOCA . ...... ' .............. ............CENSUS TRACT .................. Owner's Name . .. ........................................................Phone .... ... .......................... Address . . . /3 _ . . .�._.'" r. .''�.. City ............. ......_.. .......... J Contractor's Name __-- e....license # lA.W3. .y. Phone .............................. Installation will serve: Residence Apartment House Com rcial❑Trailer Court ❑ Motel ❑Other .....41,a 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 o Cloy 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 see ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ) ] SEPTIC TANK YSize._3.____ ±... ._ ............... Liquid Depth ... .....•........._ Capacity _ --------- Type ,�1.... Material.. No. Compartments ...�---..__... Distance to nearest: Well ________sd..�..........-Foundation ..... Prop. Line ...,S1,5r........ LEACHING LINE ] No. of Lines ------------------------ Length of each line----------------------------- Total Length ............................ 'D' Box ............ Type Filter Material ..... ---Depth Filter Material ........................ ��?�,,,'�� Distance to nearest: Well _...... Q._ .__ Foundation __......C1��f '_.. Property Line .-..t7 ..... 6UIT Depth -----q- Dra+�aeter' - �C.1_� Numfasr ----------- - Rock Filled Yes No Water Table Depth -•------------>`°9--/'7----------------------Rock Size _.�.yix"It.�... Distance to nearest: Well ...............�a.-!................Foundation _... Prop. Line ....�.................. REPAIRirADDITION(Prey. Sanitation Permit# .-....•..----------------------------------- Date -----_-----_- ..-......_I SepticTank (Specify Requirements) -------------------------•-----------•-•-•---------- ....---.....----------- • ........................... DisposolField (Specify Requirements) -------------------------------------- •---•................•-•--------•--•---••._......----•-....---------•--•---•--•...._..--•-•... ----------- ... ----------------------------------------------.----------------------------------------------............................................................................................ (Draw existing and required addition on reverse 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 licew 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 _. - hJ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYz:-;,. y ------•-----••------- ----------------------------------- DATE BUILDING PERMIT ISSUED ---------------__ --- - ---- ............ --------------------- ---DATE ..._:---------- ADDITIONAL COMMENTS ---------- ---------------------------------------------------------- - --------------------------- -------- ----------------------------- - ------*.-.-.•-_-.-..•.-.-.-. --------------- --- --.. .-•--•................... .. ----- ... Date ......_. .... ....----•Final Inspection by: _ .. '� - EH 13 2b 1-68 Rev. 5X SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M