68-551 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: l APPLICATION FOR SANITATION PERMIT --- ----- ---------------- .��-�� (Complete in'Triplicate) Permit No. ---------=----------------------------------------------- ________________________________________________________ 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -- -'-------------•--------- CENSUS TRACT Owner's Name /f �-a-f--, -----------------phone .----------------------------------- Address --------F" 7 t-------� -------------------- City ---- --_ - ------ ------------------------------------------------- Contractor's -------------------------------------------•- - Contractor's Name --- r �✓�- --,-----------------License #IfF ?Phone ----------------------- .----- Installation will serve: Residence U?/Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other --------------------------- Number of living units:-- --I---- Number of bedrooms __K----Garbage Grinder ------------ Lot Size 2-,q ----------- Water Supply: Public System and name ------------------------ -----------------------------------------------------------_- Private Dq Character of soil to a depth of 3 feet: Sand'o Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam,- 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 -------------------------- 4 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 ____________________________________-_ Distance to nearest: Well ____ __________________ Foundation ------------------------ Property Line ._________________._____ SEEPAGE PIT [ ) Depth ____________________ Diameter ---------------- Number -----------.--------------__ Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation __.----------------- Prop. Line --------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date -------------------._______------_) SepticTank (Specify Requirements) - ---------------------------------------------------------------------------------------------------_•---------------------------- DisposalField (Specify Requirements) ----------------------------------------------------------------------------------------------------------------------•--------------- _ , • ------- - ----- --------- -� -------------------- (Dr existing and required addition on reverse side) I hereby certify that 1 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. Nome owner or licen- sed agents signalure 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 be subject to Workman's Compensation laws of California." ne Si g - --------- ----- - ---------------------------- --------------- Owner BY -- - Title -------- ---- -- ------------------------------------------------------- an ow er} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------- ----------------------- DATE .�.r "J� ------------------ BUILDINGPERMIT ISSUED -------------------------------------------------------------------- ---------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS -------------------------------- ----------------------------------------------------------- _ ------ = Final Inspection b -------------.Date -- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M