78-205 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------- (Complete in Triplicate! Permit No...� �_._ ------ ----------------------------------- ---- -- Date Issued- i ---- ----------- ----------- __-__--___..................... This Permit Expires 1 ,Year From Date Issued i 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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION.-- ��+ --2. .--/-c------ - ---- --- -- ---------CENSUS TRACT--------- --------------------- Owner's Name --- Phone ----------------------- -------------------------- - Address2�Z ----- -x ; . CItY - - zip Contractor's Name.---.- .r --------------f---------License Phone--------------------- ------------ Installation will serve: Residence Apartment House.❑ Commercial❑ Trailer Court ❑ Motel ❑ Other---------------- ----- --------------------- Number of living units:______.-------Number of bedrooms-------------Garbage Grinder- ----------Lot Size--------- ------ Water Supply: Public System and name------ ------------------------------------------------------------------ ------ -----------------------------------------------------Private ©i Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam F3f_�Iay Loam LJ Hardpan ❑ Adobe ❑ Fill Material-- ._--l...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' ---------- ----------___.---.----.--- 'D' Box------------Type Filter Material---------_---------Depth Filter Material-----_-------.------------------------- x-________..____________- Distanceto nearest: Well_, -_---_--_.--.Foundation___- .__:.`:__________Property line------ PIT [ ] Depth ----- ---------Diameter--------------------Number----------- ---___,-__-_--___-_- 1 = Rock Filled Yes ❑ No ❑ WaterTable Depth----------------------------- ----- ---------------------Rock Size------------------------------------------------ Distance to nearest: Well........... ..---- -------------------.__Foundation--------- ---- ---------- Prop. Line-.-__--..._-_ REPAIR/ADDITION (Prev. Sanitation Permit#______----------------- -------______-Date_-___--_____..__.-.-----.-- ) Septic Tank (Specify Requirements)----- ---------------- ---- --------------------------- - ----------------------!"------------------- ---- Di oral Field (Specify Requirements)?.!_,4 - �--- --- --4-44--,. ______-' ------------------------------------------- -- "' Y' __ ~------ -"--- x ter' - ------------------------ - ---- -- - --- - ------------- (Draw ex ting and re uired addition on reverse side) 1 hereby certify that 1 have prepared ibis 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 licensed 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 By------------------- - -- Title ----------------- (If other than owner) FOR DEPARTMENT USE WLY APPLICATION ACCEPTED BY --------------------------- --DATE.------- r` ' DIVISION OF LAND NUMBER------------------------------ --- - ------ --- ----------- -------------DATE------------------- ADDITIONALCOMMENTS---------------------------------------------- ------------------------------------- ---------- --- -------------------------------- ---------- ------------------ -------------- --- --------------- ----------------------- ------------------------- ------------------------------------------- ------ --------------------------- ------------------------------------ �- � . Final Inspection b / --------- -- -------------------------------------- --- - ------ pY�------------ / � - ---- -- -�� ------------- ----------------------- Date- -- - ------: EH 13 24 1f SAN JOA IN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M