68-818 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT � + Permit No. $- (Complete in Triplicate) This-Permit Expires 1 Year From Date Issued Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is mad_ '�5?7liance with County Ordinance No. 549 and existing Rules and Regulations. t O i JO"ADDRESS/LOCATION -------CENSUS TRACT Owner's Name -------ea.�---------cox-:------------------------------------------ --------------- ---.Phone •--------------- ------ •----- A • ------------------------------------•--- Contractor's Address city ° is Name -- (� `� ------=--------License # - - --:------------ Phone --------- •-------•---••------ Installation will serve: Residence 0 Apartment-House❑ Commercial :❑Trailer Court i❑ Motel ❑Other �_ I Pf I i Number of living units------------- Number of bedrooms -.�J-_------Garbage Grinder _ __ Lot Size ,ft �C_ .._._-_ Water Supply: Public System and name -----------t------------------------------------------ ------------------------------------------ -------------Private Character of soil to a depth of 3 feet: Sand[] Silt❑ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam.E] 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK jQ /��/ —L Size/-'7 f/t �r}' Liquid Depth �----•----------- ��- Material-& Vifj_4 No. Compartments .............:.... V Capacity 1, -Q- Type r I i Foundation -. __- -_-_� Distance to nearest: Well -� _-�----------------------- ,�� ----____-- Prop. Line -------- LEACHING LINE No. of Lines ----�-------------- Length of each line--- :,' �_�___--.-__-__ Total Length fa ____- d �. 'D' Box �_A�_ Type Filter Material,�, Depth Filter Material ��'7---_---_- I ' / < s i Distance to nearest: Wel! - .�-----_--_--- Foundation __----____-___ Property Line - -.:.`.-..-.-_- SEEPAGE PIT [ ] Depth ;j� XeDiameter ----------------- Number -,.Z-------------------- Rock Filled Yes� No $ftv Y" Water Table Depth ---_� -- r �� Rock Size Distance to nearest: Well -----------------------------------------Foundation -------------------- Prop. Line ---------------..----- 1 REPAIR/ADDITION{Prev. Sanitation Permit# ____________________________________________ Date ---------------------------------- t . Septic Tank (Specify Requirements) -------------------------------------------------------- ----------- -~-------------------------------------------------- t 1 Disposal Field (Specify Requirements) ---------------------------------11* [ fDraw 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 Co nsation laws of California." Signed ------------- ------------------ -- -------------------------------- Owner i f BY - - - - --------- ----------------------- Title --- --------------- o er than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -c ��I r ` '" ---------------------------------------------------- DATE ---- ------------- � BUILDING PERMIT ISSUED ------------------------------- ----------------------- ------------ -------DATE ------------------------------------------ + ADDITIONALCOMMENTS -------------------------------------------------------------------------- - ----- - ' � t -------------------------------- - - ---------------------------------------------------------'----------------------------------------------------------------------------------------------------- ------- --- ----- ----- ` - - - - - --------------- ------------------------------------- --------- --------- ---- Final Inspection b -- Y y ` ---- _ ------i----- ---------------------- ----- ---- ---- ------- - --------- -- pY� -- -------------- ----------- --- -----------------------------------------------------------Date --f--- -- --- - ------------------------- SAN ---------------; ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.