71-569 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: i APPLICATION FOR-SANITATION PERMIT - --- --- ------------------------------------------ 711, "c Permit (Complete in Triplicate) No,. ----------------------------------- This Permit Expires 1 Year From Date Issued x Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct andinstall the work herein described. This application is made in compliance with County Ordinance No. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._i `. .. -yr C�. '� -''�' }----------- CENSUS TRACT Owner's Name ` - Phone :'; /��if �f 1 Address -- ---� � a% --- - �p/� �� -- �--t�<��`-�-- -- - ----. City ��-� - --------------------- ------------ --- Contractor's Name -_.,/ ?�" - � ---a . ---------------------------=--------License Phones✓---- �. Installation will serve: Residence ['Apartment House,0 Commercial :❑Trailer Court iO Motel ❑ Other -------------------------------------------:. f r Number of living units:--- Number of bedrooms _ _-___Garbage Grinder_ Lot Size Water Supply: Public System and name ---------------------------------------------------------6-------------- -`----- ---------------------PrivateX Character of soil to a depth of 3 feet: Sand'[3 Silt❑ Clay ❑ Peat❑ Sandy Loam 'C] ,*,Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If yes,type ----------------- _,---__---- (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 TANKCiA :Size'_ 0Liquid Depth �i CapacityA�49e9__>__ Type s` ;' . Material_di:P�de� No. Compartments _-____-�2---__....._ Distance to{,nearest: W,el -------- ________________Foundation __ ------------ Prop. Line _ _...---------- UA LEACHING LINE No. of Lines ____ __ __________ Le gih of each line__ J �____..____ Total Length ,, _ _____________ --'D' Box '•-42t;!�-- Type Filter�.Material f6x,l .Depth Filter Material .�� ------------------ Distance _____-Distance tsolinearest: Well _-_ ________�__ Foundation _,,� -------------- Property Line ___ ________-,....__ SEEPAGE PIT Depth _ 09 4-1--_ Diameter' _ - �-- Number,*------ - Rock Filled Yes ,r No ❑ oc -- -------- Water Table Depth ------ �--------------------- •- -Rock Size. --------------- : ! Distance to nearest: Well ------ a _________________Foundation --- --------- Prop. Line _____! ---___..__.. REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------I f" { SepticTank (Specify Requirements) ------------------- -----------------------------------------------=- --------:----------------•.----------------------------- Disposal Field (Specify Requirements} ---------------------------•--------------------------------------------------------------------- ------------------- --------------- - --------------------------------------------------- --------------------- ---------------------------------_------- '--------- = ------------- (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 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 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." Signed ---------------------------- ------- --------_---- ------------- j------------ ------ Owner By ------------------- --- - -- Title � . - --- � .------- ------------------ ---- (If other t owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- 'e' f'-------•- ---------- ---------- -------------- DATE ---J6�1- A'�~�7----------------- 4 BUILDING PERMIT ISSUED ------------ I� l DATE ------------------- ------------------- -- ---- ------ ADDITIONAL COMMENTS P1 ----'- ----------~----'-------------------------- ---------- ----- ------------------------`------------------------------------------------ ----------------------------------- -------------------------------------------------------------------------- --------- Final Inspection by: --- '-°� --------------------------------------- -------------------------------Date < r�7 --- --- --- -------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 91='b'i3 Rev. 5M }