69-130 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT '• -- ----------------- -------------• ------------------- (Complete in Triplicate) Permit No. ------------------------ This Permit Expires 1 Year From bate 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 pules do Regulations: JOB ADDRESS/LOCATION _- ----------- - =-------------� r;. ------jCENSUS TRACT -------------- ------•--- Owner's Name ----------------------- ---------------- - - --- Phone .---------- ------------ ------------------------ Address ----- %L+ �� City ---------------------------------•- Contractor's Name ---- ------.License # ------------------------- Phone Installation will serve: Residence P Apartment House❑ Commercial ❑Trailer Court !,❑ d Motel ❑Other --- - ------------------- Number ------------------ ------------ Wa er Supply:IPubfic'Syst�m and Hamer of bedrooms --------Garbage Grinder --_= Lot Size 1��-•�..�i�}�_______________ � a Character of soil to a depth of 3 feet: - Sand' ..Silt - Clay P ❑ ❑ y-.❑ Peat❑ Sandy. Loam--Clay Loam ❑ -- Hardpan [] Adobe '❑ Fill Material ------------ If yes, type ---------------------------- (Plot --_-_____________._ - -(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 ---------------------- Liquid Depth - _______.________ Capacity _/� fJa---__-- Type ------ ------ No. Compartments -------------- ---•- ��.. Material---------------- � .. Distance to nearest: Well ------.,T-P----------------------Foundation ....../9 Prop. Line ........ LEACHING LINE [ ] No. of Lines __.__------------------- Length of pach hne_-,CFO------------------ Total Length -. -�.._......__._ 'D' Box�,.,Type Filter Material ----------Depth Filter Material -- l -----------------------•---•----•- Distance to nearest: Well ------------------------ Foundation ----------------- ------ Property Line.---------.--.___--.:---- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes C3 No .C] d• Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------_-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) i SepticTank (Specify Requirements) -----------------------------L---------------------------------------------------------------:-------------.._-_-.--------------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------- ------------------------------------ --- -----:- --------------------------------- ------------ ------------------ --- -------------------- ---------------------------------- ------------------ ----=-------- --- ------------------------------------------------------------------------------ (Draw existing and required addition on reverse side) ; V hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin r 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 b e subject tom orkman's Compensation laws of California." J - Signed ------L-\ - --------------------------------------------- Owner BY ------------------------------------------ ------- --------------------------------------------------- Title ---- --------------------- - - ------------------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - -------------------------------------------------- DATE --- BUILDINGT PERMIT ISSUED ------------- -------------- --. ----------------------------- - DATE ------------------ ADDITIONAL COMMENTS ---- --------------------------------------------------------- - --------------------------------------- ` ----------- -------- ------------- - - - - - - Final Inspection by: ---------- =------------------------------------------------Dater- 'SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M