72-1063 - Laserfiche WebLink

Home Browse Search

FOR OFFICE 6SE: � a -- `� APPLICATION I<OR=SANITATION PERMIT '-/ ---------------------„------------ - 63 (Complete in Triplicate) Permit No. ----------------------------------- 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. 549 and e�isting Rules and Regulations: p JOB ADDRESS/LOCATION � ---------------------------- ---- ---- - --\-CENSUS TRACT -------------------------- Owner's Name _ . 1_ _ J'?. :—-----------------------------------------------------------=---------------------Phone `� ` •? . Address ------ A-,4-&A_AU------------------------------------------------- City _e6_--------------------------------------------- Contractor's Name 411..----- ------------------- ----------------=--------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 ❑ 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 ----- ------------------(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 I ] Size------------------------------------------_----- Liquid Depth _.______________________. (� Capacity -------------------- Type -------------------- Material---------------------- No. Compartments -------------_------ Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------- .. _......- o 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 C- WaterTable Depth ---------------------- -------------------------Rock Size -------------------------------- Distance to nearest: Well ______________________________________Foundation r____._________ .... Prop. Line ____._____ ........... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------.--------------------------) Septic Tank (Specify Requirements) ---- f----------------------------------------------- ---------•-- ------:- - Disposal Field (Specify Requirements) ---------/-_/Z716;4---- -------1 lJ-----------------------------'---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------=--------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 1 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 "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 subje toy - -orkman's Compensation laws of California.” Signed ---- � Y ------------------------------------------------- Owner BY ---------------------- ---------------------------------- ------ Title ----- ---- - -- --------------------------------- ---------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- -__._____/ W_a ------ DATE __._�Q__--x-'/.' "-_-_. BUILDING PERMIT ISSUED --- ---------------------------------------------------------- ----------------------------=--------------DATE ADDITIONALCOMMENTS --------------------------------------------------------------------------- ------------------------------------------------ --------------- ------------------ ------- ---- ----- ---- ----- --- ---------------------------------------------------------------------------------------- --------------- ------------------------------------------------------------ ------------------------------------------------- - ------------------------------------------------------------- ------------------------------------------------------------------ ------- .. - --------------------------------------- - - - - ----- ----------------- - ------------------------------------------------------- --- ---- ---- ---- - - -- Final Inspection by- ----------- ------ -------�- ----------- ------Date _..... -' ------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT {/�j��. - 'V E. H. 9 1-'68 Rev. 5M