COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT ....................... (Complete in Triplicate) Permit No. -.'1 ............•••. ....... ...... This Permit Expires 1 Year From Date Issued Date Issued .x!.� ��, Application is hereby made to the San Joaquin Local Health District for a permit to construct a d install the work her described. This application is made }n compliance with,County Ordinance No. 549 and existinVRules and Regulations: , JOB ADDRESS/LOCATION ....�Q 1T? ,..... !y -� 'T i �� .: a11'e ../7..�1 CENSUS TRACT Owner's Name .:C r�:it'• j '- .- �... �� - ;1. �'`'1... ....•................. ....................P one .........._...... Address ... . • c.. -jf1'�)!'_P. City Contractor's Name .................License .. :... License #, 1� �S' - Phone Installation will serve: Residence Apartment;House 0 Commercial❑Trailer Court ❑ 'A r. O. f .. , Motel ❑Other....:.= r-•----•............................ '�' Number of living unitsy . .:'.-_ Number of bedrooms`s�......Gorba a Grinder ,. 9 !� _-. Lot Size A ..l�.'w.. ................. Water Supply: Public System and name ................:. ... � e ........................................ . .....Private.............. 11� Character of soil to a dZipth of 3 feet: Sand n�'.Silt❑ Clay ❑ `Peat_❑ Sandy loam ❑ •. Clay Loom ❑ Hordpong Adobe ❑ Fill Material .....`.'.'.:. If yes,type ...:........... (Piot plan, showing%size of lot, location of system:In relation to wells, buildings,'etc. must_be placed on reverse side.) v NEW INSTALLATION: (No septic tank or see page pit--permitted if public-sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK I ] Size.................................?....._......._. Liquid Depth .......................... 1 Capacity ....t............... Type ............. Material....................... No. Compartments ....................... Distance to,nearest: Well r:. `.._...__....Foundation .............1... Prop. Line ...................... LEACHING LINE __.___.....Length of each line........_.._...i__:.. 'r Total Length ............................ [ � No. of Lines .............. , �J D' BoxType Filter.Material Depth Filter Material � -- - _ �...._ .......................................`�y _ Distance to nearest: Well ........................ Foundation Property Line _ ..... SEEPAGE PIT Depth ....... ............ Diameter......:.:- Number --�..-..-..-..:_"Rock Filled Yes ❑ No ❑ Water Table Depth ................................Rock Size Distance to nearest: Well ........................................Foundation .................... Prop. line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................) Septic Tank (Specify Requirements) . { Disposal Field (Specify p uirements q 1 ..fi t....�... ./J/ct _ 2 ��►: _......1...._.s. .. . ...... .................. DisRe F----------------------- ......................................•-.....-----• -----...------....------......_....._....-----...----------.....---•---- ---------------------•-----•---•-------•--.............. (Draw existing and required addition on reverse side) I hereby certify that.1 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 ........ ..... .............. . ..::. Owner By .......... ";`Title ( of er t an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 6Y ...... ._ ....;e ............................. DATE .......d �7...T..�... i ... ,ABUILDING PERMIT ISSUED ........................................:....................:....__..............._..._..................DATE ........................:...........:....... DDITIONAL COMMENTS ................................. .....--•................•------......----..................................... ..................................................... _ p...... ....... . -...k _._-- ...... ...........................•-----... Final Inspection by: ....:. x-: ...................................Date ......... .. ..._. SAN JOAQUIN LOCAL• HEALTH DISTRICT i F N 13 24 1_,an oe., c.i