71-983 - Laserfiche WebLink

Home Browse Search

FOR oFFI- -CE uSE- - : APPLICATION FOR SANITATION PERMIT ---- - - - ---- ----------- - - - ------- Permit No. -11'----rf-�--��-- (Complete in Triplicate) This Permit Expires 1 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT QN _ � --;- -- �/ .� ---------------CENSUS TRACT __S. -------------- r ------ Name --- OK G4/ � Phone ------------------------------------ ,if °�- f Address --- --- - - -- -��---------------------- city 460-1 -� -------------------------------------------------------- License ------------------------ -- -------------••---------- Contractor's Name ----�; /l�Q /__ ----------------------------License #��-?/-vf.__� P h a n e Installation will serve: Residence Apartment House❑ Commercial _]Trailer Court ',❑ Motel ❑ Other -------------------------------------------- Number of living units..--/---- Number of bedrooms S------- Grinder s Lot Size pf-_f__� ��------------- Y #�1 Sand Loam Private Water Supply: Public System and name _____ _� y__� ------------------ at F] ----------- --------- -- -. Character of soil to a depth of 3 feet: Sand' Silt Clay tectal ___________ If es e❑ Clay Loam' Hardpan ❑ Adobe ❑ ill Ma t ,l 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! Sized r,� -- -. --------- Liquid Depth _ Capacity, ______ Type d _ Material .017 Id"'--- No. Compartments _- ------ Distance to nearest: W ---------- -_________-Foundation _� _�______ Prop. Line _______ r / LEACHING LINE No. of Lines 09 ---- Length of each line:��10--- ------ Total Length s _r____:___ 'D' Box '/ __ {pth Filter Material '0'6 _� �-� Type Filter Material/�� - -- ------- --------------•-•-------- Distance to nearest; Well -J- ----------- Foundation z0-.----------- Property Line _,:70--_...___ SEEPAGE PIT ;jQ Depth r��_--- Diameter �;;�_-__ Number ___ ►_._______---- -- Rock Filled Yes Na c Water Table Depth '----------------------------Rock Size/. ~._:� ------ ----- �y � ---- Distance to nearest: Wel! ____X ___________________Foundation �� .41�� _ _ Prop. Line�/• ______. REPAIR/ADDITION(Prev. Sanitation Permit# _______.._____---------------------------- Date ____________________.___---------_) Septic Tank (Specify Requirements) ------------------------------------------- '-------�-------------------------•----------------------------_- --------------------------- DisposalField (Specify Requirements) ---------- ------------------------------------------- -------------------------------------------------------------- ------------- - -------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ----- --71----!:rt--------- ------------------------------- --------------------------------- ----------- (Draw existing c5nd 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 Rulesand Regulations of th.etSan Joaquin Local Health District. Home owner or licen- sed agents signature certifies the followir4: "I certify that in the performance+of.tthe 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." s Signed ------------------------- ---- --------- s ----------- Own e -------------------------- BY ------------------------------ ----------- Title {!f onowner) r FOR-DEPARTMENT USE'O'N!Y APPLICATION ACCEPTED BY-,. . ______ _ ______€�_________.___ -------------- -- -- ------------- DATE 'tel �7/ -------------- BUILDING PERMIT ISSUED ---------------------------------------- ------- ------------------------------------------------------DATE -------------•----- ----------------------- ADDITIONALCOMMENTS ---------- - -- -----------------------`----;;--------------------- ----------------------------------I-----------------=--------------------------- --------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-- --------------------------------------------- --------------------------------------------------------------------- - - ---- --- Final Inspection by: w�..c- ----- ---------------- _ ----------------Da- - SAN JOAQUIN LOCAL HEALTH DISTRICT H. 9 1-'68 Rev. 5M