69-314 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- --- - ------------ --- ----------------- ------- Permit No. �" 1��_. (Complete in Triplicate) ------------------- This Permit Expires t Year From Date Issued --------------------------------------- Date Issued _ _ - -_ � ______________ --___- -_________-___ 07-240 03 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 ._�_ *Residence - "r'y` °CENSUS-TRACT`-_T-'-4:_"+_______..._./" ---Owner's Name -.---- --- _..__Phone ".--` ----------- Address -- d -- . City ` --------------------------------------------------- Contractor's Name ------ -------. ---- --- ---- -" - ---.License #/- Phone ---------------------------- -Installation will serve: #ment House❑ Commercial ❑Trailer Court i❑ Motel F-1Other ----- ----------------------------------- QQ Number of living units------4(------ Number of bedrooms _ ___Garbage Grinder _- .._ Lot Size 2°_`X --------------------------- Water _ _ ___Water Supply: Public System and name ------------------ --------------------------------•------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material -- -------- If yes, type ____-_________._________ N {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 seep a pit permitted if publicsewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK'[ Sizes Q �(--F _ Liquid Depth V----- Capacity -1(000------ Type Material-;0^-a---- No. Compartments __ r � � � Distance to nearest: Well -------- -Q------------------Foundation -------10--------- Prop. Line ---- ------ ----- LEACHING LINE [-K No. of Li s _ .___R._-- Length of ach ine:,___.I._D_0------------- Total Length _�a d___ _____ 'D' Box ___ Type Filter Material v-_n_.!�__Depth Filter Material __-__ _--------____________--__-_-__-•- Distance to nearest: Well _____ fj_� ________ Foundation _____.ir_`�_.__________ Property Line. _________ _________ [ s/ � << �' SEEPAGE PIT Depth ._____.__ _ ___ Diameter _____________ Number ______._ __._____ _ ___ Rock Fi led Yes No13 i 4 / I Water Table Depth -------- ---- --------- a":________"_"-�- " -------Rock Size .--c� - >1 _- Distance to nearest: Well ___________ _$2 .____-_____,_---Foundation .___ ----------- Prop. Line _____________________• REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------A------ Date ---_------------------------------) SepticTank (Specify Requirements) ----------------- - ------ ------------------------=--------------------------------------------------------- Disposal Field (Specify Requirements) --------:--- --------------------------------------=------------------------------------- --------------------- ---------------- - (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 ct to Workman' pensati.on laws of California." Signed Owner _ 04 BY ------ -- Title ,--------------------- If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ _ _ ---------------------------------------------------------I DATE --------------- BUILDING PERMIT ISSUED ------------------------------------------------ ---- --------DATE ------------------------------------------- ADDITIONALCOMMENTS --------------------------------------------------------------------------------------------------------------------------------------------- ------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ --- ------ ----- _ _ --------------------------- -------------- ---------------------- - W Final Inspection by: _-- _ pate _ -._-- --- - --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M �`