69-516 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------ -------------------- ----- 4 Permit No. (Complete in Triplicate) ---- -- ----------------------------------------------- Date Issued This Permit:Expires 1 Year From Date Issued --------------------------------------------------- Application is hereby made to the San Joaquin Local Health District for a per 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/LO-CyAyT�I�O�N � © -�^ --•-- ----------- --- TRACT ---- ---------------•----- Owner's Name --�a " '`-'QL�` "a.r„`1----------- ---- - -- Phone -----= Address ----_ 7_1SeQ City _ --•------ .. Contractor:s_Name ::-. a- -�, == J = License-#- 13- Phone Installation will serve: Residence., Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Otfie.r �"1 --------------- _ -=-- -- Number of living units--------r___ Number of bedrooms -_ __---Garbage Grinder ------------ Lot Size __-______________ _______ t. Water Supply: Public System and name --------------------------------•----------------------------- -----------••------------ ---•-- ----- Private Character_ofsoil_#o-a depfih_of_3_feet:—Sand_Q __Silt:[]_Clay_Q._.. Peat E1 Sandy Loam --•-•C-lay�Loam;[]"� Hardpan ❑. Adobe,M 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.] N4 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) (I� PACKAGE TREATMENT { ] SEPTIC TANK'[ E Size------------------- ------ Liquid Depth -----------------•-------- \ Capacity - -- ,eTYpe -------------------- Material ------------------- No. Compartments ---------_--_..... _ Distance to nearest: Well ____________ -----------------------Foundation -----r�---------------- Prop. Line __.---------------- LEACHING LINE [ ] No. of Lines ---------- �---------- Length of each line---,----------------- i' Total Length -------------------------•-- D' Box ---- ------ TypeFilter Material --------------------Depth Filter Material -------------------------------------------- Distance tolnearest: Well ------------------------ Foundation ------------ ----- Property Line ----------------- ------- Distance 1 SEEPAGE PIT [ ] Depth gg--_-I-,--------Diameter ---------------- Number ----------------------:- --- Rock Filled Yes 'E] No . WaterLTabl D pth --------------- - ----Rock Size -------'" i - ----- Distance to Barest: Well ---------- -----------------------------Foundation __'"_-_------------ Prop. Line ------------- ------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---_----------�r--------------- ) Septic Tank (Specify Require encs) --------- --------------------- ------------------------------------------------------------` -,. ------------------- --� Disposal Field (Specify ,Requireme ts) .f ---------------------------------------------- ----------------- ----- ---------- `------ -- --------------------------------- - ! (Draw existing and required addition on'reverse side) I hereby certifyi„that Ihave prepared this application and that the work will be done in accordance wit S n Joaquin h 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 beco subject to Workman's Compensation laws of California.” Signed - -- -------------- --------------------------- Owner -------------------- Title _ .Ltt ---- ---------- -- ----- --- -- (!f other than owner) FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY _. __ DATE �-P1 - - -------------------- BUILDING PERMIT ISSUED - -----------:---- -------------- DATE - ----------------------- ADDITIONALCOMMENTS -------------'---------------------------------------------------------- ------ ------------------ ----------------- ------------- --------------------------- ------------------------- -a-- ------ ------------------------- ------ -------------------------------- ---------------------------- ------------------------- - Ipc -= ------ Fina! Inspection by: Date -- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M