69-326 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ` Permit ----------- - ---------"-"-" --------------- � (Complete in Triplicate) -------- -------- ------------------------------------- , Date issued _f s r =_`-------_ " This Permit Expires l Year From 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: JOB ADDRESS/LOCA ON . 'I I CY---Rt---�k___BIW —A-�--------------------------------------- -- ------CENSUS TRACT r Owner's Name ----------------- � _ cam llgr_ .�w��-----------------_--------------- ------------- Phone a--C>_�i[ -------------------=-� S '��------ =x � - -------------------------- Address ---. City --------- - ----------------------- ------------------------------------ Contractor's Name ------------------- License # ----------- ------------ Phone --------------------- -------- Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court I❑ Moteler ------OF6C;a---%----& rN-l�- Number of living units------------- Number of bedrooms ------------Garbage Grinder ___- Lot Size ----. Igv)-_A----------------------- Water Supply: Public System and name ----------------------- --------------------------------------------------------------------------------------Private ❑ f �. Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam:❑ .Hardpan ❑ Adobe SII 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,) // i PACKAGE TREATMENT f I SEPTIC TANK'[ Size---.w---'--_�C-- --- - ------------------ Liquid Depth .---L�1Z-_ ..-,----- Capacity .4 -----..-- Type -1_�_fP7y .-- Material-.C�-:----- No. Compartments ---�--- Distance to nearest: Well ____°Q.t�-------------------- I p• --Foundation _-.-: -�------_---- Pro Line ---.-6....... ----•- LEACHING LINE [ ] No. of Lines -------/--------------- Length of each line---------g ---- - "--- Total Length ,_---1o_'----------- 'D' Box ..---------- Type Filter Material --------------------Depth Filter Material __----_-__" -- Distance to nearest: Well`-_----------_--.'-`---- foundation __._-- :-._= Pro}�erty Line --------------------- -- SEEPAGE PIT [ ] Depth --------- ---"------ Diameter ---------------- Number ----------------- ---------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- 1 Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------- ------------- REPAIR/ADDITION(Prev. Sanitation Permit# -_----------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ----------- ------- -- ---------------------- --------------------------------------------------------------------- Disposal Field (Specify ---------------------- --- - -Requirements] ------------------------ # ' - t ------------------- ------- ---- ----- ---------------------------=--------- -- ------------:_-------- -------------- ----- _-- --- ------------------ ` 1 �_ _ _T_____R______ . - - - - ---------- !"(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: "1 certify th . n the perform nce of the work for which this permit is issued, 1 shall not employ any person. in such manner as to beco a ui�je to Wo#mon;f Compensation laws of California." Signe Owner - -- --------------------------------------------------------- ---- ------------------------- Title ---------------------------- ------------- ----- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------- ------ /-. D E --------------------------------------------------- - ----- -- BUILDING PERMIT ISSUED ----------------- -- --------- AT ADDITIONALCOMMENTS ------ --------------------------------------------------------------------------------------- ------ --- --- ---------- - ---- ------- k ----- - ---------------------------------------- ----------- ------------ - ------- ---- ---- --_ ----------- �'fi1� Dat Final Inspection by- -------------------------------------- -� --- e - -----� c� ---- -------------- SAN ------ --SAN JOAQUI LOC HEA H CT E. H. 9 1-'68 Rev. 5M.