70-99 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' � r � �� - -•��---x APPLICATION FOR" SANITATION PERMIT � R {Complete in Triplicate} —Permit �-� ---------------------------------------- Date Issued-------------- ------------------- .____--_-___ This Permit Expires 1 Year From Date Issued - _-7o Application is hereby madezto_.the.San—Joaquin„Local-HeaIth3 District for a permit to construct and install the work herein described. This application.is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: t ` Ow ADDRESS/LOCATION .--.-r _ -_- - -- - -- --CENSUS TRACT �er's Name Phone ----------- Address _._._ l1 _ - = City/�� 60 . __ _ ____ ________________ Contractor's Name --------------------------------/nt Li¢ense�# = +L _ -Phone -- Installation will serve: Residence [ ApartHouse-F1 CommArcial ❑Trailer Court Motei ❑ Othe'r r E Nurrilber of living units:____ _ Number ofnd 'om ;;a_�Garb ge G�r.i er _ _. Lot Size- --- a g -------------------------- CNN I Supply: YIr``r �. `� e �-------------- ------------------Private ❑ . Water Su I Public System and name Character of soil to a depth of 3 feet: . Sand''❑7�S It `., Cla 1 Peat ,�.. ❑ Y ❑" ❑ is Loam [] Clay Loam ]] Hardpa Silt E Fill Material __ '_ If yes, type ------------ ____ (Piot plan, showing size of lot, locatison,,of system jln relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: f(No septic tank or seepage pit permitted if public sewer is available within 200 feet) Q PACKAGE TREATMENT #[ ] SEPTIC TANK,[] Size------------"-47 -"--------------------------.__ Liquid Depth _.------------------- Capacity _---------------- Type -------------------- MaterlaN---------------- - .No. Compartments ,41� Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -------- ------------ V\ LEACHING LINE [ j i "No. of Lines ________________�-____. Length of each line___-____._ -___. ___- Total Length ' 'p't Box ------- Type Filter Material ---------------------Depth Filter Material _____________ f) Distance to nearest: Well ------------------------ Foundation ----------- ------------ Property Line -________.._______._ ! -: . SEEPAGE PIT N Depth ----...-------------- Diameter ---------------- Number ------.-----------_--- ------ Rock Filled Yes .❑ No ❑ I Water Table E epth ----------------------------------- ------------Rock Size ---------------- r Distance to nearest: Weill ------------ Prop. Line -------------------- REPAIR/ADDITION(Prev. Sanitation-Permit s#" '__ _________ _ -___ pate __ __._._.__.____-_._ j 1 _ _ -- Septic Tank (Specify Requirements) ___________________._____._ isposal Field (S cif Requirements) ___________ ------- --- ----- - -------- ------- ------------------------------------------------ ------ --- ------ ----- - ' {Draw existing and required addition on reverse side} I hereby certify that I haveprepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State L ws, 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 perforni6nce of the work for whichYth 's permit is—issue-d-,'I shall not employ p y an y person in such manner as to become subject to Workman's Compensation laws of California." Signed ---------- ------- --- -------- -------------- Owner - -- ----------------------- BY --- ------------ -- ----- 1 Title - " 11 oth an owner } - - '-- ------ -- ----- ----------------- ------------------------- ,t J. FOR .DEPARTMENT USE ONLY M APPLICATION ACCEPTED {i --- dz';----- -- - - ---- ----------5 t------------------ ------------------. DATE: BUILDING PERMIT ISSUED = ----------- ------------- -----------------DATE ------- -----• _ _ ADDITIONAL COMMENTS ---- ------------ ---------- f --- j1 ----------- - --------------------------------------------- -- -------- ------ i I ----------------------------- ------ --------------------------------------- 1 .--- -1--------------------------------------- ---------------------------------------- = -- ------------- =---- ---- - - -) ------------------------- -------- _ a Final Inspection by: ----e�------- - --- ----------- I E. Date _.2 -. -- 7 SAN JOAQUIN LOCAL 'HEALTH DISTRICT ,. 'A" ) E. H. 9 1-'68 Rev. 5M. ," '