71-596 - Laserfiche WebLink

Home Browse Search

- FOR OFFICE USE: /` APPLICATION FOR SANITATION PERMIT ___________________________________._1--/- ------- (Complete in Triplicate) Hermit No: _7�._� y --------------------------------------------------------- Date Issued ------------------------------------------------- ------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance ith County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCA? ON . ------- - -------- ------ �`� '-- ? -CENSUS TRACT ///�------------------------- Owner's Name � 1P - l�1z' Cit----------_- Phone 'Y4��s4��`.LP - Address Tf��,, - - - - ---- ---- -- ------------- --------- Y w�f Contractor's Name____ ______�O�---------License # -/��',i !�___ Phone 10V ' Installation will serve: Residence Apartment House-E] Commercial ❑Trailer Court ;F]Mo el ❑ Other ------------------------------------------ Number of living units:----!------ Number of edrooms .._____Garbage Grinder ------------ Lot SizeAP__-____________45____-_______ Water Supply: Public System and name --- �C.----_- Wh�--------------------------_------------------------------------------Private ❑ 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'f ] 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 to nearest: Well ________________________ Foundation ------------------------ Property Line ___-___-____----__-_--_- SEEPAGE PIT [ ] Depth,--.__-_>.__________ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No ❑ Water Table Depth ------------------------------------------------Rock Size ---- --------------------3 Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# Q_ ________________________ Date - (`��'�r!* ________) ~y Septic Tank (Specify Requirements) ----- ------ - - __-_-____--- Disposal Field { pecify Require ents] '� / + -/ ra------- -------------------------------------------------- (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 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 Workman's Compensation laws of California." Signed ------ I Owner - ----------------- ------------------------------------------ BY =, -------------------- Title - -------------------------- ------------------- lf other than owner[ " FOR DEPAitTMENT USE ONLY APPLICATION ACCEPTED BY -- _______________ DATE .... '" `�� BUILDINGPERMIT ISSUED ---- (Q----------------------- -----------------------------DATE -------------•---------------------------- ADDITIONALCOMMENTS . -------- ----- ------------- ------- --------------- -------------------------•---------------- --------------------------------------------- -a3 1--- - ; � --- _------- . . ------------------------------ Wqw---::::_:__::::::__________________::____------::__ - --- - -------- ---- - Final Inspection by. - ate ~° ' It SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M �i�