71-034 - Laserfiche WebLink

Home Browse Search

^=-€tOFFE USE: APPLICATION FOR SANITATIONPERMITPermit No. (Complete in Triplicate) ------- ---- �/� Date IssuedThis 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 existing Rules and Regulations: JOB ADDRESS/LOCATION AENSUS TRACT --------------•----------- ._ �--/---�------ � �`- --- ' Owner's Name -------Phone`�-ra-----------------•--------------------: �S'r e - --� ------------------------------- Address ----t� -�--��--�•---------------------------------------------------------------- City --- - / G� -- Contractor's Name - _, ��-, �_.Pa -License #/L` - lS•TsZPhone Installation will serve: Residence XApartment House,❑ Commercial ❑Trailer Court i❑ rMotel ❑ Other ------------------------------------------ � Number of living units:_J____ Number of bedrooms _/------Garbage Grinder ___ ___/�____�✓_ Lot Size1��--- jWater Supply: Public System and name ------------------------------------ ----- ------------------------------- ------_Private[ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ feat❑ Sandy Loam .❑ 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,) f PACKAGE= TREATMENT [ ] SEPTIC TANK Size--.-_ _�� . - --- - Liquid Depth �� -_----.----._---- p Capacity _Ll-� ,-- TYP �� Material No. Compartments -"---� ---- ---- Distance to nearest: Well ---- ` ---------Foundation ------- Prop. Line ; - •- LEACHING LINE No. of Lines _______ _____________ Length of each --------- Total Length -��---•----------- fp>r T000,0 D' Box . - Type Filter Material s�' p, epth Filter Material !--'?- -------••-----------•- fwY Distance to nearest: Well -- ---------- Foundation _ ----------- Property Line _____" --- ---------- 'll SEEPAGE PIT j ] Depth _ Diameter ----------- ---.. Number ---------------------------- Rock Filled Yes ❑ No ------------ Water Table Depth ----.----Rock Size -------------------------------- t Distance to nearest: Well ----------------------------•------•----Foundation -------------------- Prop. Line --------------.------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic Tank (Specify Requirements) ------------- --------------- -------------------------------------------------- Disposal f=ield {Specify Requirements) -----------•------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I 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 Mules 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, it shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed _.--------- Owner ----------------------------- 4/ Title - I (If of than owner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------t-------------C= '------- DATE --- �V---------------------- BUILDING PERMIT ISSUED _-- / ;,f _ DAT - _ ------------------ ----------- .1 ADDITIONAL COMMENTS - t `'''�� - - -------- � s ------------- --------------------------------------------------------- --------------------------------- ---------- ------------------------------------- ' Final Ins ection b � --------------Date ------ --.. Y------- - SAN JO' AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M w