72-813 - Laserfiche WebLink

Home Browse Search

"OR OFFICE USE: APPLICATION FOR SANITATION PERMIT - -------------------------------- Permit No: (Complete in Triplicate) Z .------_____--------------- This Permit Expires 1 Year from Date Issued 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/LO CAT! N. ." _ C : ' �-�-- -- ------ -----------� .-- {d="--------- --------------CENSUS TRACT .......... Owner's N ------ ----- ------- ------Ph------------- fir} t� - Address ____. !-.- - __. ---"-_-_/__. CitContractor's Name � � = '--------.License # 14Y - . - Installation will serve: Reside Apartme t ousg°❑ Commercial ❑Trailer Court i❑ Motel E]Other ---- _ Number of living units:--___.__rM... mber of bedrooms ---Garbage Grinder ----------- Lot Size -------------------------------------------- Water Supply: Public Systemand name -- ---- -'------ _ -----•-------------------•-------------------Private ❑ Character of soil to a depth o;3 feet: Sand'❑ 1 SiIt.O Gay Peat❑fit Sandy Loam; Clay Loam "❑ Hardpan ❑ Adobe ❑ Fill Material ----'-99;------ If yes, type _---__--.----_-.------_--- +t_ 1t 1 }5 (Plot plan, showing size of Iot, location of system in relcitioh. to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permittted"if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK[ ] Size------- - -•----•---- ------------------------ Liquid Depth .-------------------,----- Capacity -------------------- Type ---"_ -:_�. ----- Material--------------------.- No. Compartments -----...._. Dista ce to nearest: Well ------------------"--------_:_____-_Foundation ---------------------- Prop. Line ---_---_-----:-;_--.-. LEACHING LINE [ ] No. of Lines ------------------------ Length of each, line---------------------------- Total Length ----------- ---------------- t 'D' Box ------------ Type Filter Material _----.-----I------Depth Filter Material -------------------------------------------- Distance to nearest: Well ----------------_-----_ Foundation ------------------------ Property Line. --_...--..--------.-._-- SEEPAGE PIT [ ] Depth -------------------- Diameter ----_ ----------- Number -------------------.-------- Rock Filled Yes ❑ No .C) Water Table Depth --------------` Rock Size c5 Distance to nearest: Well --------17 �-------------------------Foundation -------------------- Prop. Line ........--..--.-...... REPAIR/ADDITION(Prev. Sanitation Permit#---.�-• ----------------------------------- Date --------.----------------------.-- J Septic Tank (Specify Requirements)'':.-`.'r,-'- ------- - --- -- ---- --------------------------------- ------- - ------ Dis osaI field S ecif Requirements) n-,�--- F P Y q ] '-------------------•---•---------- --------- r— i ; f ------. -- -------:�.-------��- ��- ----------------------- - --------------------------------------------------------------------------------------------- (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. Horne owner or licen- sed agents signature certifies the following: "I certify thof in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to W an's Compensation laws of California." Signed ---------------- _ _._ _ - Owner- By F%=-- - rL Title --- --- ---- - Y ------------- ---------- - - - -------- --- --- --- - (If other than owner) 1 w F,QR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ------------------------------------------------------------- DATE ---------- BUILDINGPERMIT ISSUED -,------------------------------------ --------------------------------------- ---------------------------DATE ------------------• --------------------- ADDITIONAL COMMENTS -------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- --------- --------------------------------------------------------------------------------------- -------------------- --- -- ----- -- --------------- -- Final Inspectionby: --- ---------------------------"I------------------------------------ Date �- i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M