71-394 - Laserfiche WebLink

Home Browse Search

€ORkOF--ICE USE: APPLICATION FOR SANITATION PERMIT -------- - ----------------------- -- Permit No. _�1--�-9�---- (Complete in Triplicate) --------------------------------------------------------- Date Issued . _: -71__-_-- --- -------_------__-----------------------------_-- This Permit Expires 1 Year From Date Issued l Application is hereby made to the /anoaquiniLocal Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance o. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _ --- - __-- -- -- ---- --- CENSUS TRACT -------------------------- Owner's Name ------ ` _ Phone I Address ----------------5- U City �--------- --- Contractor s Name - 3. `=------ -- s i cense # _ _ _ hone Li Installation will serve: Residen�e ❑ partment House❑ Commercial ❑Trailei Court ;❑ - t Motel ❑ Other ----- ----------- Number --- - ' Number of living units:__.---------- Number of bedrooms ------------Garbage rinder __________ Lot Size ._____-______________________________.____- Water Supply: Public System qnd name --=-------------------•------------------°------------------------------------------- Private Character of soil to a depth of 3 feet: Sand'❑ Silt EJ Clay F1 Peat El Sandy Loam Clay Loam ❑ Hardpan-F-1" Adobe ❑ Fill Material ------------ If yes, type --------------------------- (Plot plan, showing size of'1ot, 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 f ] SEPTIC TANK:[ ] Size--------------------------------------------- -- Liquid Depth -----------------.-------- " Capacity _.------------------ Type -------------------- Material---------------------- No. Compartments ---------------------- 14 Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- ea 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 i❑ --------------------Rock Size ------- ------------------------ Water Table Depth Distance to nearest: Well -------_ ----------------------------Foundation.-------------------- Prop. Line --------------........ REPAIR/ADDITION(Prev. Sanitation Permit# ------ i-6_e------------------ Date SepticTank (Specify Requirements) ------------------- ------------------- ------------------------------------------------------------------- -------- ----------•-•- Disposal Field (Specify Requirements) __----- -.a f - ----- '-- ' ''F^' ` -------------------------------------------------------------------------------------------------------------- ------------------------.-------------------- ___________________ ________________________ _ ________-__--------_________________-_.--------__:________________._----------__________-___ (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 Son 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: "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 Workman',sXImpensation laws of California." Signed --------------------- ------------- , -- -------- --- Owner ep B ----- -- ------- _ Title ,- Y (If other than owner) FOR DEPARTMENT USE ONLY /l APPLICATION ACCEPTED BY --- - ---------- - ------------------------------------------------------------------------ ----, DATE -7_' ------------------ BUILDINGPERMIT ISSUED ------- --------------- --------------------------------- -----------------------------------DATE.-- ----------• --------------------------- ADDITIONALCOMMENTS ------------------------------------------------------------- ---------------------------------------------------------------------------------------------- b _________--------------------____----------_______________________________________-______________-_______ _ . ______________________________________________________________________________________________________________________________________________________________^______ ____________________ __.______ --------_--------------_-----------__ __ ___ _ ______ _________ ----------------------------------------------------------------- ----------------- __.___ Final Inspection by: = ------------------------------------------------------------------------.Dated - - -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.