71-929 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT GG Permit No.7�__J-_�_9__ (Complete in Triplicate) ___________ _____ This Permit Expires ] Year From Date Issued Hate 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 Cou ty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC) TION - '9- - --- -�__ --------- _- --------- r�/----fGQ--------.--CENSUS TRACT S_q!---------------- Owner's Name �!__ 1 - ------ ---- --- - - ----------Phone ------------ Address -.----- - - - - - - - ----- -------- - / -- --- --------- City --- - - --- ---- - -�----��" Contractor's Name _ _ _________ _ ________ f L License # ZY 3r?"Phone ------------------------------ Installation will serve: Residence " Apartment House❑ Commercial '❑Trailer Court ;❑ Motel ❑ Other ----------------------------- Number of living units:_____1____ Number of bedrooms _____Garbage Grinder --------- Lot Size ------ ------------Private �. Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam n____ 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 I ] SEPTIC TANK'f ] Size---------------------------------------------___ Liquid Depth --_----__-__.--______---_ �p Capacity - Type ______________ Material______________________ No. Compartments t t y Distance to nearest: Well ------------------ -----------------Foundation ---------------------- Prop. Line ---------------------- LEACHING ------------------ ._LEACHING LINE [ J No. of Lines ------------------------ Length of each line---------------------------- Total Length ---------------------------- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material -------------------------------------------- Distance to nearest: Well ________________________ Foundation ----------------------- Property Line _-___-__-_______-_-_-___ SEEPAGE PIT [ Depth ---------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No C3Water Table Depth ---------------------------------------=---- -Rock Size ---------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------------- ------- REPAIRIADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------..--------------) SepticTank (Specify Requirements) ------ ---------------------------------------------------------------------------------------------------------------------------------- osdl Field (Specify Requirements) - Q � ___ ra' + � + � _________ ---- ------- -------�--------------------- 3.� x .2-s ------------- raw 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 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 become subject to War n's Compensation laws of California." Signed - -- ------- Owner ,- ---- BY -- ---------------------------- Title ------ --------------------------- (If other tha wner) _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - ---- - - -- -------------------------- DATE J?_�_ BUILDINGPERMIT ISSUED --- ---------------------------------------- -----------------------------------------------------------DATE -------- ---------------------------------- ADDITIONAL COMMENTS ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- { --------- ------- ---- - - ------- ---- - -------- - ----------------------------------------- ------- Final Inspection by. ------------------------------------------------------------------- ---Date -- ��-/--- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M