SU0007492 ENG DES PLN - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE. APPLICATION FOR SAWiTATION PERMIT Permit No. (Complete in Triplicate) ' IDate issued Tris Permit Expires 1 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/LOCATION ----- -------------%--�------ ------------- -- C�t��y.% CENSUS TRACT Owner's Name -:- =v ^' Phone: . .., Address _ - - - ----- Contractor's Name _.: City License #/.. Phone ------ -------- Installation will serve: Residence `Apartment House❑ Commercial ❑Trailer Court :❑ Motel ❑ Other Number of living units:_ _____ Number of bedrooms .-_....Garbage Grinder __-__.__ Lot Size ---- 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 ❑ Fill 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,) 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 'D' Box . _ -- _ _ Type Filter Material __ ------- --- ---Depth Filter Material - ----------- - _- ._--______.__-__. Distance lo nearest: Well __ _._.-...- Foundation ...... --____ _ - Property Line --- ------------------ SEEPAGE PIT 1 Depth ..... --------- __ Diameter --------- Number _ ..---. _ _- ------ Rock Filled Yes ❑ No Water Table Depth ----------------------- ------ ---- -- - ------Rock Size -- -------------------- -- Distance to nearest: Well ---------__._.___.-------._- _..___-_Foundation -------------------- Prop. Line _-----__-.-__--_.. REPAIR/ADDITION(Prev. Sanitation Permit# -------- ______________________- - -____ _ Date ----------------------------------) SepticTank (Specify Requirements) - ---------"----- ------------------------------------------------------------------------------ --------------------------- posal Field (Specify Requirements) ---- -57 ------- - ------- ----------------- --------------------------------------------------------------------------------------------------- ----------- ----------------------- (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 licer-- 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 to Workman's Compensation laws of California." Signed ---- ( � -----�----- Owner By - ---------- - ---------------- -- (;_., Title -c_ - _.....-�_., � -------------- (If - ....(If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . . _ DATE `' R. BUILDING PERMIT ISSUED .------- . ----- .._ ._.... . ---------------- ------ ---... DATE . ----------------------------------------- ADDITIONAL -- -- ---- ---------- ------- ------- ADDITIONALCOMMENTS --------------------- -- ------------•------•--•-•--•-------------......... _ .. _- - - -------- - -.... - - - ._.....------- -------- ------- ---------------------- - _.. _ ------------ ------ - R - --- ............................_.. ..... _.... ........ -- - --------- ... .._. �� . F .... _..--... _...Date Final Inspection by: . '`'--. ----- - -- ------ - ---- -- - ...39-- ` ! 79 SAN JOAOUIN LOCAL HEALTH DISTRICT V