72-669 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMI C,,,,� 1 Z) —6 6 7 ---------- --- --------------------------- - ------ Permit No. (Complete in Triplicate) -____________________________________________________ This Permit Expires 1 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: J08 ADDRESS/LOCATION ------- --/W- -- ..------------_-------CENSUS TRACT -------------------------- Owner's Name -- -------------------------- -------------------Phone . _, � Address ----------- r- City ----------------------------------------- 7 Contractor's Name a ' --------------------License #/01c. ----- Phone `f _JW� ...T Installation will serve: Residence ❑Apartment House^❑ Commercial :[]Trailer Court ❑ Motel ❑ Other -------------------------------------------- r Number of living units:---- ----- Number of bedrooms _______Garbage Grinde ____.- __--- Lot Size -7-5------ Water Supply: Public System and name --------------------------------------------------------- - ------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ 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,) PACKAGE TREATMENT u{ ] SEPTIC TANK:[ j Size-----------------Y __,.__-__-- ------------ Liquid Depth ----------------....,_.... �^M' % Capacity Type Material------ ---------- NO' :—Compartments ______. .............. .� Distance. to nearest: Well --------------------'_----:- '_-----Foundation ---. ---- .`- ---- Prop. Line -----------..._-.---•- 4�„ ___ Length of each line___________________ ______ Total Length -___-_..--..._ LEACHING LINE [ j No. of Lines ____________________ g ---,----_-_--- 'D' Box ------------ Type Filter Material ---------------------Depth Filter Material----'_________________________________________ Distance to nearest: Well ------------------------ Foundation ------------------- -- Property Line _______-__----_•_-----__ SEEPAGE PIT [ j Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled' Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size §Distance to nearest: Well ------------------- -----------Foundati n --------------_.---- Prop. Line ....___. ............. REPAIR/ADDITION(Prev. Sanitation Permit# _._ -"_- --g_______________ Date _fp _7-":Z_ L-_-_--) + s Septic Tank (Specify Requirements) ---=-- _ r- - ._J..•--•- - ------------------ Disposal Field (Specify Requirements) r___ � /g ------------ X -2r_ -- -_- _. ---- jie -- ---- !- --------- E - - ------------------------- -----------------------------------------------------------------------------------------------------------'----------------------------------------------------------- -------------------- (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: "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------------------- ---- Owner t By --------- -- ----/ f' c Title ---------- (If oth t n owner) O FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------ DATE _-- --- _ -- -.- ----------------------------------------------------------- -- BUILDINGPERMIT ISSUED --- --------------------------------------- ----------------------------------------------------DATE ---- -------------------------------------- ADDITIONAL COMMENTS ------------------------------- -- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- -------------------- --- -- - � 3- - ------------- -- - - --------- ----- ----------------------------------- - -- - -- - ------- - - --- ---------------=------ FinalInspection by: ----- ------ ------ --------------------------------------------------------------------------------------------------.Date --- - -- - --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. _ri—