69-962 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: ---- ----------- ----- ------------------------------------------ �9- q a a° (Complete in Triplicate) =----- ---------------------------------------- ------- Date Issued This Permit Expires ] Year From Date Issued a 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 o. 549 and existing Rules and Regulations: /; rte. JOB ADDRESSAOC`ATION . �rf----� _4* f "- LIMIVI tNSUS TRACT --• Owner's Name /�- -------------- ----Phone ------------------------------------ Address `� --- ------------------------------------------------------------------•--. City ' ij ------------------------------------------- { /� �✓ Contractor's Name .__ ./G • �✓// f�/ � License #� �.'�-per _ Phone •� Installation will serve: Residence j Apartment House,❑ Commercial ❑Trailer Court Motel ❑ Other -------------- ---------------------------- Number of living units:_./-.-.-_ Number of bedrooms3-------Garbage Grinder ��'4- Lot Size --a� "r _ "------•--- Water Supply: Public System and name -------------------------------------------------------------------- --------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam .0 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 jpublic sewer is available within 200 feet,) PACKAGE TREATMENT [ SE=PTIC TANK Size_ ---------------- --- Liquid Depth �-__------------- Capacity �0�_.---- Typ701040 � ____ Material.it� .a.-__ No.'Compartments Z..- ........... rest: Well --- � ---------------------Foundation __ -------- Prop. Line ---6 ------------ X -= ------ X LEACHING LINE No. of L�nesDistance to n�------------------ Length of each line--/ _----- - Total Length _p�.-`------ -- 11 D' Box - Type Filter Material vloe.Depth Filter Material .--________________________________ � � F Distan to nearest: Well __ '� __..----_--�- Foundation __ --- Property Line. ___ _. SEEPAGE PIT Depth __A$7---.--_ Diameter11 j.3 - __---- Number ___ .----.__�-.-.---_ Rack Filled Yes (� No i❑ Water Table Depth ------- Rock Size 'y ` i Distance to nearest: Wel! __ W-------------------------Foundation 7-. Prop. Line _._.:____.......... .__ REPAIR/ADDITION(Prev. Sanitation Permit r# ------------------------------------------ Date -----------------------------.----} SepticTank (Specify Requirements) --- ---------------------------------------------------------------------------.--------------------------------------------------------•--- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------ ------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------- ------------------ - -------------- -------------------- - - ----------------------------------------------------------------------------------------------------------------------------------------- (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 --- &---- Title ------ BY - ��` (If othe an owner) ff FOR .DEPARTMENT 'USE ONLY APPLICATION ACCEPTED BY ------------------/-------------------------------------- - DATE __1- -�`I ................ BUILDINGPERMIT ISSUED ----------------------------------------------------------- ------------------------------------------.-DATE - ---------- ----------------------------- ADDITIONALCOMMENTS -- ------------------------------------------------------'*------------------------------------------------------------------=------------ ------------------ ----------- ----------------------------------- ----------------------------------------------------- - ------------------------------------------------------------------------Q------------------------------ Final Inspection by: ,Ci' Dat _ .. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.