70-195 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT — i ---------------------- ---------------------- Permit No: --7D r��S (Complete in Triplicate) This Permit Expires l Year From Date Issued 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 existing Rules and Regulations: - r JOB ADDRESS/LOCAT N . � �- --!- '-------------------- ---------------CENSUS TRACT ----`5- - - --------- ---- - . t Owner's Name -----------------Phone ----- -------------------- - ------------------- Address "sr - ---- ---- ---- - ---- ------------- ---- ----------- -- ! ' -- --.License # /�� - Phone Contractor's Name -- � - - � -- - -- ---------- ------- - ----- - - -. Installation will serve: Resideric Apartment House❑ Commercial ❑Trailer Court ',❑ t I Motel F-1Otherk----------- --- ----------- a Number-of living units:--f------ Number of bedrooms --- ----- Garbage Grinder ------------ Lot Size ---_--------------------------------------- - = - Pr ivateWater Supply. Public System and name --------------------- CChbc-fer of soil`toa depth'of3 feet. • San l Silt - Clay -Peat-❑ Sandy-Loam lay-Loom [� ❑ •�,_ Hardpan ❑' Adobe ❑ Fill Material ---------- If yes, type ---_-_--------------------- i (Plot..plan,-showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) NEW INSTALLATION:�w [No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT, [ , SEPTIC TANK![ ] Size------------------------------------------ ---- Liquid Depth -----------------_------- . ?Ca oci.tY-,I.-- --- -- Material---------------------- No. Compartments--------------- Type V `bistance to nearest: Well ---------------------------------'--Foundation ---------------------- Prop. Line --:-------------....- LEACHING LINE [ ,)..,,.,.No, of Lines,---=-------------------- Length of each line---------------------- Total Length ------•':- -.---- 'D' Box ----------- Type Filter Material --------------------Depth Filter Material -------------------- ___---_-_...._-.----.- f Distance to nearest: Well ------------------------ Foundation - ---------------------- Property Line ---------.-------- _----- SEEPAGE PIT [ ] t Depth ----- ----------- Diameter Rock Filled Yes No 0--- Number --------------------- -- - Water Table--Depth--------------- -------------- Rock Size Distance to nearest: Well ----------------------------------------Foundation -------------------• Prop. Line ----------- .......... -------------- Date ---------------------------------- Septic -------------------- - REPAIR/ADDITION[Prev. Sanitation Permit# -------------------------------------------- - - - -----• Septic Tank (Specify Requirements) ------------------------------------------------------<-------- --------------------- --------------------•-------;--- ----------------- Disposal Field (Specify Requirements) --- --(- ---------------01--------- x U ' -- ------------------------------------- --------------- --------- ---------------------------------------------------------------------- --------------------------------------- (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 --------------- ----- ---------------------i ----- --- --------------- ----- Owner ----F4024-V ---- Title ---------------------------------- (If other than owne FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . - - - - ----------------------------------------------------------- DATE s3 --'r'7 ------------- --- BUILDINGPERMIT ISSUED -------------- ------------------------------------------------------------------------- -- -------DATE ------------------ ------------------------ ADDITIONALCOMMENTS -- ---- ----- ------------------------------------------------------------------------------------------------------------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - -- -------- k ---------------- ----------- , ------------------------------------------------------------------------------------- ------- - --- ------ ------------ ------------------------------ ------------------------------------- =-------- ------ - Final inspection by: ____-- -- � ---------------------= Date = `: SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 VV6.8 Rev. 5M. 1 _