68-545 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANlTATIQN PI;:RMlT '� ' Permit Na. "� - `�� -------------------- ' �------ (Complete in Triplicate) -------------------------------------- -� --�� - Date issued This Permit Expires 1 Year From Date Issue _ 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 ------ ------ lt' I! a -- ..CENSUS TRACT --------------------" r ! ------------Phone Owner's Address -- ----- ------- --- ------- - Y - ------------------------ - License # __/ 4. "�- ._ Phone Contractor's Name al" " _ - ,` �F � y _ 5� I Installation will serve: Residence> Apartment House-[] Commercial ❑Trailer Court ',❑ , s Motel.[71 Other -------------------------------------------- / �, f Number of living units:-.------- Number 4edromsarb ge Gr" r -- ----- Lot SizePrivateI : Public S stem and name -----"" ""- 1Water Supp y YCharacter of soil to a depth of 3 feet: Sand' lt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam r r Hardpan❑ Adobe Fill Material ------.__--- If yes, type ---------------------------- k Ff .. -� {Plot plan, showing size of lot, location of system��M�in.ae�'re4rlation to wells, buildings, .etc. must be placed on reverse side.) NEW_'NSTALLATION: (No septic tank or p seepage pit permitted if public sewer ' available within 200 feet,) ? •/ Size__ "?� _. - .�?-- ---------- Liquid Depth PACKAGE TREATMENT [ ] SEPTIC TANK' Q 1 Capacity .�".�.�op -Type P�� '� Material_ t ----- No. Compartments ___ --------=•--- © r t r ®® f Distance to nearest Well __----------------------------Foundation___- -Q---- Prop. Line ------�3"_..__..--_ LEACHING LINE No. of Lines ----- ---------- Length of each line----- ---- ------ Total Length ox-lyx V----De Depth' Filter Material _II ` ---------------------------•----- I 'D' Box "-_�____" Type Filter Materia __ _-- __-- p f-�---- i ' - '� ----- Property Line ------ Distance to nearest: Well �.__O--""----1`_ Foundation - Q._------ p tY r 22 SEEPAGE PIT ' Depth- __ -".------- Diameter--�.t-" Number __"__."-_,Z"----.------- Rock Filled Yes No'❑ .11 WaterTable Depth I'--.----4 Rock Size -------------------------------------- Water T = Prop. Line'--"-. -------- .... Distance to nearest: Well ----___-_---.""__-" k REPAIR/ADDITION(Prev. SanitationPermit# --------------------------------- : ------ Date --------------- ------ Septic Tank (Specify Requirements) ---- ` '----- ----- -•-------------- ' S-------- ---------------------------- ---- Disposal Field (Specify Requirements}. '-------------- ------------------- ----------------- ---- Ir t Y y ---------------- -------------- --------- I - ---------- -------------- ------------------------ --- --- -... (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 1'rcen- sed agents signature certifies the following: ` ' "1 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 ork anIss CCo�m'po cation laws.of California." - t Signed ,ti}�a"r t� ` - - ------------"�^T" - -- --- Title ------------ ----------------------------------------------------------- - (If other than owned FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _._.____`__--"------------- ----- --------------------------------------------------- - DATE BUILDING PERMIT ISSUED ---------------- -------- --------------------------DATE - ADDITIONALCOMMENTS --------------------------------------------- --------------------------------- ------------- -------------------------------------------------------------------------------------------------- _ ------------------------------ Final -------- -- ,. Date -- -- ------- Final Inspection b-Y- - ----- -]lel-=Z kj --�-------------------------------- ----- ----- ----------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M