70-571 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / -- Permit No.14-----� 7,< (Complete in Triplicate) ------=--=----------------------------------------------- ________________ This Permit Expires 1 Year From Date Issued Date Issued _______ _ -- .D 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/LOCATION , ' -- ---------- ----------------------CENSUS TRACT -3S Owner's Name ------ r--- �-- - --- '-------------------------------- ---- Phone ------------------------------ Address ----------------1 -41--- ------ - - - . . City .x-----. -----•---- -- Contractor's Name -------. ---- ---- -.License # _�� - Phone ---------------'-----------__-- t. \ t Installation will serve: Residence partment House❑ Commercial❑Trailer Court ;❑ _Q Motel ❑Other ----------------------------------------- Number of living units--------- �---- Number of bedrooms ----�---Garbage Grinder ____ _.--- Lot Size -------------------------------------------- { Water Supply: Public System and name --------------------- -- -----• -- -- --�------ - ---- -- -' ----------------------Private El of soil to a depth of 3 feet: Sand'❑ Silt❑ C y El Peat❑ Sandy Loam E] ClayLoam.❑ h Hardpan ❑ Adobe' Fill Material ------_------ If yes, type ---------------------------- {Phot plan, showing size of lot, location of system in relation to wells, buildings,-etc. must be placed on reverse side.) NZ NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is available within 200 feet,) �d PACKAGE TREATMENT { ] SEPTIC TANK [ Size- � _�G�r> __ 5_�-- -_ ---------- Liquid Depth _--- _----_- -... Capacity16194 4'-IType e -a-_---- Material_ 't ._--_ No. Compartments _a--.............. Q Distance to nea st: Well --------- gip-- ---Foundation -_----IP -_---- Prop. Line ._ -- w LEACHING LINE [ Na, of Lines ------ -------------- Length of each hline------- ------.-.---- Total Length . . 7 'D' Box -- -_-- Type Filter Materials--__- /`_-_-_Depth Filter Material -------- .----_---_....-...___-_ ; Distance to nearest: Well ------- Foundation ---------_1_,V-.`---- Property Line- -------- ------ _t S � " SEEPAGE PIT [ Depth --_P2--- --_-- Diameter --- _----- Number ----------- ------------ Rock Filled Yes [� No ❑ Water Table Depth ----------------- ---440--- ------------....Rock Size --- ------- r � Distance to nearest: Well -------- __-_- -------------Foundation ------/_P-.._---- Prop. Line _.X--------------- REPAIR/ADDITION(Prev. Sanitation Hermit# -------•------------------------------------ Date ----------------------------------11 Septic Tank (Specify Requirements) ---------------------------------------------------- ---------------._.--------------- ------ Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ----------------------- (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 t orkman's Compensation laws of California." Signed --- --------=- - r= --- - ------- Owner / ----------------- -Title - e - - ---- ------ --------------------- By ---------------------- ---- -- - a . (If o leer than owner) FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .-- �_( - ------------=------- - ---------------------------------------- DATE 7 --------- BUILDING PERMIT ISSUED --------------------------------------------------------------- - -----DATE ------------------- -- - ------------------------------- ADDITiONALCOMMENTS ---------------------------------------------------------------------------------------------------------------------------------------------•---------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------=----------------------------- - ------ ----------------- -------------- -- -- ---- --------------------------------------------------------------------------- ------------------------------------- - -------- ---------------------------------- ------------------------- -- - - ----- - -- - Final Inspection by: • �-- ------ - -------------------------- Date -, SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.