68-641 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: -__ _- , APPLICATION,FOR SANITATION PERMIT , --- -- ---- — P n Triplicate} Permit No.(Com _ ___ /. k ,.�.� This Permit Expires ]'Year From Date Issued Date Issued _tel=/ s/f 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 mdde in c n+pliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT _�4/D "" ------CENSUS TRACT ------ ---------------- wner's Name _ _ - -- - ,��--------------- ----- - - - - = - P one Address -- -39� -� ---- --------•------- , - __ ------ - � City _. ----------------------------------------------- --------- --------- Contractor's Name ---- � ---------------- -------- --------�--- License # -------------- Phone -. _____ _ _______ J Installation will serve: - Residence 0 Apartment Hous Com rcial❑Trailer Court ;❑ - - Mote! ❑ Other K - - -- Number of living units:_-___ ___-__ Number of bedrooms --______.__ i ""----"Garbage Grinder - e ------ el— ----------- .Y p ------------------------------------------------------ -------- - Water Supp'I Public System and name.-_.__- _ - ---- ---•--- ----------------- --- ---- ---------------------------------------------Private, Character of soil to a de th of 3 feet: Sand ❑ Silt❑ Clq. y ❑ Peat❑ Sandy Loam Clay Loam:❑ , .Hardpan ❑ Adobe'❑ Fill Material ------------ If yes, type ............................ {Pl'ot plan,.showing size of lot, location' ofrsystem in' relation to wells, buildings, etc. must be placed on reverse side.l 'NEW INSTALLATION: (No septic tank or seepage pit permitted if'public sewer is available within 200 feet,) �J PACKAGE TREATMENT [ ] SEPTIC TANK Size----. ------------------------------`------- Liquid Depth -------------------------- �. Capacity _#----------------- Type ---`------___� 'Material___________ __________ No. Compartments . Distance to nearest: Well ----------- -- --------------------Foundation --------:------------ Prop. Line ------------------- - LEACHING"LINE ' - [ ) No. of Lines ------------------------ Length of each line---_-----------------_...... Total Length ------------- Box ----_------- Type Filter Material --------- ------ _-__Depth Filter Material ----------- -------------------------------- Distance to nearest: Wel! ------------------------ Foundation ------------------------ Property Line PIT ------------------- SEEPAGE ----- �� C 1 Depth --------------------> Diameter ---------------- Number ----------------------------- Rock Filled Yes ❑ No Water Table Depth ------------ ------------ - --------Rock Size - ...... -to nearest: Well ---_-____:-____ Foundation ----------------------------- --------- Prop. Line -•---- REPAIR/ADDITION(Prev. Sanitation Permit# ________________----- -: - - r ---- ------- =`"� Date - --------- ---------- Septic Tank (Specify Requirements) __-__--_-__ - ' Diosai Field (Specify Requirements) 3 _ --- _ I l (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 Son•Joaquin Local Health District. Home owner or licen- sed .� sed agents signature certifies the following: ' "I certify f at in the performance of the work for which this permit is issued, I shall not employ any Person in such manner as to bec m subject to Wqowne Compensation laws of California." r Signed Owner By - ----- --"- -� ( A ----- Title _--�:r �/ (If other than [ - `r� FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED --- --- -------------- --------. DATE ~..--- ------------------------------------- ----- ADDITIONAL COMMENTS ---- '---DATE -------------- ----------- ------------------------- ------------- -• ------------------------------------ Final Inspection by: _ -- ------- ----- ----- ---- -_-_- -- - --------------------------------------------------------------------------------- --------------------- -- - - - - -- - ------.Date -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M