69-986 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: _ � � APPLICATION FOR SANITATION PERMIT ------------- T` Permit No. = (Complete in Triplicate) -----------I---------------------------------------------- Date Issued ---------------------------------------------------- This Permit Expires 1 Year From 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 Rules JOS ADDRESS/LOCA ION ._9��- ----� - - -- ------- -- --- - --- ---- -------------- - -._-CENSUS T CT .. Owner's Name _.�--r "� ------------- -- Phone i { Address ---- _ --------- - - City ------------------------------------------ _ Contractor's Name -- _ -_ _ ___.License # .S�i��-?. --- Phone __YG�--31 v� - - - --- ----- - --- -- ------- -- ---- Installation will serve: Residence �partment House❑ Commercial�❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:___f_.-_ Number of bedrooms __- __Garbage GrinderQ-. Lot Size ___ ____________-__--_______________ ¢ Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private [G}� Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay -❑ Peat❑ Sandy Loam C] Clay Loam;❑ E �( k Hardpan E] �Adobe' , Fill Material -----NO- if yes,type ____________________________ y (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) p� ' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[? S_ize�:` ,fix-S - -•--------------------- Liquid Depth --------------------.--- 6.1- Material__ No. Compartments Z� Capacity 12 V-0------ Type p 14 Distance to nearest: Well __,7`~a_- ______________Founndo tion _140---______ Prop. Line __-_ -___._...- LEACHING LINE [I4' . No. of Lines .____. _____________ Length-of each line-- 1-v_____..------ Total Length 410__--� _____________ i 'D' Box Type Fitter Material S'_ ` _Depth Filter Mate __ ---------- 0 to nearest: Well - ------- Foundation _A0_____________ Property Line _-5-.._..___-_._ ti SEEPAGE PIT < 'r-- Depth --------- Diameter % ------- Number __--.------ ______________ Rock Filled Yes No f Water'Table Depth d� X` Rock Size--p'?:_X_j---------------- ; Distance to nearest: Well Ql_ --------------------------Foundation _ Q-_-------- Prop. Line ___`S-------- j REPAIR/ADDITION(Prev. Sanitation Permit# ------- ------ --------- Date ------ --------------------------) Septic Tank (Specify Requirements) ---- -------------- ----- ------------ ------------------------------------------------------------------------- ---------------•----------- t Disposal Field (Specify Requirements) ---------------------------------------------------------F------ ------------------------------------_-------- ------ �? F --------------------------`'.,------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------- '------------------------------------------ -;.------------------------------------------------------------------------- ---------------------- -------------------------------------------- -- ------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and thixt 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- y sed agents signature certifies the following: r "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 be e s b' :t T Wo an's Com nsation laws of California." Signed -- Tx's'---------------------------- Owner BY = /C� ------------------- ---- Title r (If other than owner) FOR DEPARTMENT LlONLY I' APPLICATION ACCEPTED BY --------------- ___-- DATE I --�-d- --------------------- �7- --------- BUILDING PERMIT ISSUED - -- -- � � � �� DATE --------------------------------------- - -------------------- ADDITIONAL COMMENTS - --- - -------------- - cs L'r - --- ----------------------------------------- ADDITIONAL -------------- --------- - - - --------------------------------- -- ------------------------ -------------------------------------------------------------------------------------------------------- - - - ------ . . ---- -- ---- -------- FinalInspection by: ---- -- ----- - - - -------------------------------------------------------------------------------------------Date -- 7� 1------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.