71-424 - Laserfiche WebLink

Home Browse Search

FOP,OFFICE-USE: APPLICATION FOR SANITATION PERMIT --' Permit No. ---------------- - ------------ ------------- I� in(Complete Triplicate) =--------- -- - ------------------------------------------ p P �I This Permit Expires 1 Year From Date Issued Date Issued --------------------- ----------------------------------- Application ------------------ ------ _- Application is hereby made to the San Joaquin Local Health District for a permit to construct and 'install the work herein described. This application i's made in compliance with County Ordinance No. 549 and. existing Rules and Regulations: NSUS TRACT .---5 �i ------ JOB ADDRESS/LOCATION �-c�_l__��_.��---,--f•-r'----��-��'-�/-�-`-�--------�V� -- Owner's Name -- Phone City Address ------ �-�� l - =--------------- f Contractor's Name --------------- License #L- ,e - Phone Installation will serve: Residence XApartment House❑ Commercial []Trailer Court ❑ - Motel ❑ Other ---------------------------------------- Number ---- ----------------------------- --- Number of living units:.-- ---'�__-_ Number of bedrooms.f _____Garbage Grinder e�_ AOP__ Lot Size >: � `� ��-------------------- Water Supp[y: Public Systeml�and name --------------------�' Private, r Character of soil to a depth of 3 feet: Sand❑ Silt-E] Clay [I Peat El Sandy Loam E:1 Clay Loam ❑ i Hardpan, Adobe'❑ Fill Material __.__ ------ If yes,type ---------------------------- (Plot lan, showing size of Illot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) J, p -NEW INSTALLATION: (Nol'septic tank or seepage pit permitted if public sewer is available within 200 feet,) f ! �~ -- Li uid Depth k/® �P,ACKAGE TREATMENT [ ] I ' SEPTIC TANK;X Size_f - ---- ---------- ------- q p { - .,ry -' No. Compartments — -.-.-------Ca acitY loe- •-- TYpe Material-6p-174 il 4 ��ee --Distance to nearest: We ___ /_: ------------------------ - ---------------Foundationf ----- Prop. Line _-_pp ---------- - w ,'LEACHING LINE No.11 of Lines -----�______-----__ Length, of each line.,e—' �-------- - otal Length 4-1& ------- - 61 D' '�Box Zt�__,Type Filter,Material� Depth Fllter'Matterial ------ ----- ••--- r `' ' Distance to nearest: Well-__ �.--- .--- Foundation - l� - ------ Property Line 40__________ A IM f °V w. �__ ;f- �___ Rock Filled Yes No ,,SEEPAGE PIT Depth .��--------- Diameter -----_ Number -------- i� .i Water Table Depth ----- to---------- ---------------------Rock Size -------------- te - Distance to nearest: Well --------- ------------- Prop. Line --------- - ---------------------------- Date ----------- ------------------) REPAIR/ADDITION(Prev. Sanitation Permit# --------.--.t---� �w- `'Septic Tank (Specify Requirements)t ��-----�------ ------------- ----------- - ------------------- •---- ------------------------------------------------ �, Il ----�"i # �Dispasal Field (Specify Requirements) ________________ -------- -------------------------------------------------------------------------------------------------- I ----------------------------------- -- -� -------------------------------------------------------- -_----- ..,: ---------------- ' ` (Draw_existing and:required addition on reverse side) I hereby certify that I hav prepared:thEs applicationandthat the work will be done in accordance with San Joaquin ed Regulations of the San Joaquin Local Health District. Home owner or licen- County Ordinances, State Laws, and Rules ased 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 - --r - ------------- Owner ----'I� BY ------------------- -- ------ Title -------�1W�:----------------------------------------- (lf er than'�owned I G FOR DEPARTMENT USE ONLY ------------------------ APPLICATION.-ACCEPTED 6iY _________ ___ _ _- _ -------------------------------------------------------- DATE D° y BUILDING.-PERMIT ISSUE ------------------------ -------I - DATE -------------•--------- ------------------- ADDITIONALCOMMENTS �i --------------------- -------------------------------------------- ---- ----------------------------------------- --------------------------- II s -• = ------------------------- ------ 1 ------------------------ -- --------- IIr..� ....'•. ��,..•. ----------- - -------------- - ---- ------------------------ -------- - - - - - ---------------------------- ------------------------------------------------------------ Inspection b ~'.c ,.�---- - "----------------- --- ----------------- Dates^_.' _-__ SAN'JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M