71-1048 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit --------- -------------------------------------------- (Complete in Triplicate) ----------------------------- ------------------------- J Date Issued -11-10-1~ : This Permit Expires lI Year From 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: Z 7� 5 - .t ---- "` - CENSUS TRACT JOB ADDRESS/LOCATION ._ _-----_______________ Owner's Name ------------ 0 ----,.--- = - Phone ------ -- --- - e - - -- .------- --�--. city '` --------------------------------------------- Address 0�9 --- `� �. Contractor's Name --------- -]Trailer t License # __/ t '"� Phone ------------------------•-•--- - -- ------- - -- -------- ; Installation will serve: Residence partment House❑ Commercial :❑Trailer Court '❑ Motel ❑Other ---------------------------------------- Number ------------------------------ -- -Number of living units:----!------ Number of bedrooms --_7tz---Garba_ge Grinder --- -------- Lot Size -------------- ----------------------------- Water Supply: Public System and name ------------------------------------ ------ `---Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam [I 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.) V NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Ilk' Size--------- -------- ------------ ------------ Liquid Depth -------------------------- PACKAGE TREATMENT SEPTIC TANK' ] 11)Capacity - Type -------------------- Material------=:-------------- No. Compartments ---------•------------ fDistance 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 ---------------'------•----------------------- Distance to nearest: Well ------------------------ Foundation -------------- --------- Property Line ------------------------ I SEEPAGE PIT [ ]r Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled� Yes ❑ No i❑ WaterTable Depth ------------------------------------------------Rock Size -------------------------------- f Distance to nearest: Well ----------------------------------------Foundation ---------------.---- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit#-------- ----------------------------------- Date ----------------------------------) Septic Tank ]Specify Requirements) ----------------------- -- -- --- ------�-- ----------------------------- -�-:--------------------------------------;-------- Disposal - - Disposal Field (Specify Requirements) ----Z2106W—------------/-- -------- 4 ' __--------------------------------_ ------------- :---------------- ------------ ------------------ (Draw existing and required addition on reverse side) . 1 hereby certify that I have prepared this application and that the work will be done in accordwi ance th 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 subject to Workman's Compensation laws of California." Signed --------------- -- ` Owner Title - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ------ ---------- ---------------------------------- - ---. DATE '_L'1--Y -------------------- BUILDINGPERMIT ISSUED ------ ---------------------------------------------------------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS --------------------- -------------------------------------------------- ------------- r' " -- ---------------------------------------------------------------------------------------------------------------------------------------------------- U Final Inspection by: -----------.Date - ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M i`