68-727 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------- ---- - ---- ----" 1c Permit N,o: (Complete in Triplicate) _.__._._ _____________- This Permit Expires 1 Year From Date Issued Date IssuEed ___d _ Application is hereby made to't4 San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance %PM4 Coup Ordinance No. 549 and existing Rules and Regulations. 7 JOB ADDRM SS/LOCATIO ------/733-- / ----- CENSUS TRACT I------------------------- Owner's Name . _` _ «... .. _, . . .. + hone - w/ -• AAddress �__1 I- City *" -0--------------------------------------- Contractor's ------ _ T yP Contractor's Name ________ __ ___ 'YLQ_ License # ___1-- 1 Phone _ b-` _0 Installationwill serve: tRe�enApartment House❑ Commercial :❑Trailer Court f Motel❑Other Number of living units------- Number of`bedrooms ____Garbage Grinder >______.____ Lot Size d � Water Supply: Public System and name . --------- ------------------------ ----------------- .-- Private ❑ Character (soil t10 a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loa ❑ Clay Loa' :❑ Hardpan ❑ Adobe Fill Material ---- - If yd'vt s I•type a .________________.______ (Plot plan, swn`g,size Of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATIO4 Ecclopac ptic tank or seepage pit permitted if public sewer is.available within 200 feet,) y} PACKAGE TREATMENT [ ] t Liquid Depth $-----------EPTIC TANK' Size---------------- -- r----------- =-=--- --- --ity -------------------- Type -------------- Material_-- No. Compartments ------•-- -•-•-- Distannce to nearestjWelll'--- ----------------------------Foundation ----_----------------- Prop. Line -------------,--__-•-- 1 I LEACHiNGILINE [ ] No 4446s --- -----Length of-each line- .____.____________ ___ Total Length -----r__.____.___.___.__...._. T� � D' Box ----------- Type Filter Material ----------_!--------Depth Filter Material -------------------------------------------- t Distance to nearest: Well ______________-------___ Foundation --------------I------- Property Linea_________.._.____._.___" SEEPAGE PiT [ ] Depth ___ ___ _____________ Diameter ___ _________-- NVmber ---------.-_-----__ ------- Rock Filled Yes ❑ No Water Table Depth ---- `� _ ------i--------Rock Size ------- ------------------------ i DiFtante t nearesk W� A`.-------- Ire;; _ __ . ...Foundation -------------------- Prop. Line ---------------------- REPAIR, DITiON}(PPrr-egv. Sanitation Permit# ------------I-------- ----- ---------I----- Date --------------- -----------------) Septic Tank (Specs#y Requirements) --___ �.__'`_____ -. _- -- !.__" �, e 1, Dispo l Field�(Specif` ' Require mems) --_---_ --____- -- ------- -- ----------- ---- -- --- --------------- -------------- �.. --------- --------- --- --------- --------------- ---------- - ------- (Draw existing and req N ired addition 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, StatelLaws, and Rules and Reguiatiois of the San Joaquin Local Health District. Homeowner or licen- sed agents's ign atu re 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." r Signed ---------- - ----------- ��Owner BY --------�----- '' Title ---- - ------- f of r an owner.j. �\/ U< FOR DEPARTMENT E ONIX r o ; APPLICATION ACCEPTED BY ------ k - ---- ------------ ---- - --- ----- -I- ------ ---• DATE ----- --- --- - - ------------ BUILDING PERMIT ISSUED _ =---------------------------------------------- ---" DATE - ----• -- -- ADDITIONAL COMMENTS ----------------------------- `*--- I-------------- �----------- 1 - ..-- ---------------- --- ------------------------------ 4----1/---------' `• t ---------- -- -------- - L ----------------------- , . _- ---------------------------------------------------------------------------------------------_ ___- ---------------------------.------------------_- Final Inspection b Date � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. i