69-23 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 1 APPLICATION FOR SANITATION PERMIT r., n- (Complete '- Permit No. ;F in Triplicate) ---------------------- This Permit Expires 1 Year From Date 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.,5499aand ex's cn 'on JOS ItE LOC ION - 4e r , SC , _• �� T S CENSUS TACT - --------`------ Owii 'fs Name -- - - ----- -�_/ , -----Phone 9�.2----f�6,7------- � Address -. - .--- City��-------------------- - ---- -------- ------ -- - ------ ------- ----- - --- - - - Contractor's Nam �(--- c , -------- - h - --- --- - - -- ---------- -- License # ---------:-------------- Phone Installation will serve: Residence ❑ Apartment House❑ Commercial:❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- Number of living units:-.--_L_----,Number of bedrooms -_12___'_-_G rbage Grinder -._______-- L Sze -.-___-_--------------------------------- � t � o ' I l Water Supply: Public System and name ---------------------- --- .___--_-------c/_ — -- ------.-'---------------------Private ❑ Character of soil to a depth of 3 feet Sand❑ Silt❑ lay ❑ Peat❑ Sandy Loam Clay Loam;❑ ;Hardpan F] Adobe E] Fill Material ------ ----- If yes,type ---_-__-------------------- I - � (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 _T yPe -------------------- Materia - - -------- No. Compartments --------------- " Distance to.nearest: Well -----------------------------'------Foundation ---------------------- Prop. Line ------------- " LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length --------------------------3� 'D' Box ------------ Type Filter Material --------------------Depth Filter Material --------------------------------------.__-- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Linea SEEPAGE PIT [ ] Depth --__._;I_.___-- --_ Diameter _--_---------- Number ___------------ ------------Rock Filled Yes '❑ Na i❑ '' Water Tables Depth ------------------------------------------------Rock Size -------------------------------- Distance to-'nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------.------._.----- f c REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------- -------------- I t SepticTank (Specify Requirements) ----------------------------------------------------------- ---------------------• ----------.-----------------t..-------- sposal Field -[-SyRqints}t, d7 41 -----------------------------•-------------- m ----- - ------------------- -�, ----- - -=---- --- -- `----------------- ------------------ - f (Draw existing and required ad ion on reverse side) i 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, andRules and Regulations of .the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the folloswing: F "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 beco blectAo Workma 's C p law of California." Signed,= y -- - -- �- � Title [If other than owner] �. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY f - DATE 7` BUILDING PERMIT ISSUED --------------------- ----------------------------- -- DATE ------ ------------- ADDITIONAL COMMENTS -- --------- ------------------------------ ------ -------- ---------- ------ ----- -- ------------------ _3 �r Final InspeZt � - Date . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M.