70-572 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - Permit No: (Complete in Tplicate) ri 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 OrdinanceN nd existing Rul nd Reg io s: ! 't JOB ADDRESS/L TION . T G' "�""-- --- - -----C S A - Owner's Name - -------- ----------- ------ •---------_----- ----•- ------------------Phone Address V 'D-------0� . City - -------- ---p--------------------------- 46 Contractor's Name � _.__-___ ___�____._ _ _ -___-_.License # ____ Phone Q- . '- li Installation will serve: Residence3KApartment Ho ommercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- Number of living units:-_- _______ Number of bedrooms _�__ arbage Grinder --___ Lot Size __f.t✓ Q �— / ©� Water Supply: Public System and name -------------- ---- Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loan( ` 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 [ ] SEPTIC TANK[ ] Size___________________________________________ ____ Liquid Depth ---__--_____-------__--__- Capacity -------------------- Type -------------------- Material-------------------- No. Compartments ------- .............. Distance to nearest: Well _________________________________Foundation-______-.__---.___-_- Prop. Line ____._._...._......... LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------_------------------ Total Length ----------- ................ 'D' Box ___________ Type Filter Material -___--------------Depth Filter Material _________:_ I........_.............. Distance to nearest: Well ________________________ Foundation ------------------------ Property Line -------------- ......... SEEPAGE PIT [ ] Depth --------- ---------- Diameter ---------------- Number ------ --------------------- Rock Filled Yes '❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- �O Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __-____--___-_------_____-_---___-) Septi Tank (Specify Requirements) ----------------- - -A----- ------ ------------------ ...-------- ------ --------- Dis al Field S e if Re uiremen Y q 9 ---------- ----- -------7 t----- \ ------------ ----------------------------------------- — --------------------------- -- - ---------- --------------------------------------- ----- -_- --- ---------------------------------------------------_--------------------------------- (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 Ordi nces, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents g ture certifies the fo Ing: "I certify t at ' the performanc of a work for whit is permit is issued, I shall not employ any person in such manner as to bec bject to W k Co ejsat' of California." gned - -- ---- - ----------- • -•---- .......... BY - - --- -- ---- --------- /c Title - (If other than owner) FOR DEPARTMENT US Y17 el _ , APPLICATION ACCEPTED BY ------------------------------------------- ------ DATE ----- --a. .. --------------- BUILDING PERMIT ISSUED _______________ ___DATE ------------------------------- ADDITIONALCOMMENTS ------------------------------------------------ ------- ---------------- --------------------------------------------------------------- ---------- ------ --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---- ----------------------------------------------------- ------------------------------------------------------------------------------- -------------------------------------------------i-- ------------------------------------------------------------------------------------------------------------------------ �_ ------- -- -- FinalInspection by: ------------------------------------------------------------------------------------------------ - --- -----------Date ----------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M