71-854 - Laserfiche WebLink

Home Browse Search

` FOR OFFICE USE: 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 ___ ✓ -n:�.-4j----------CENSUS TRACT Owner's Name .__ __ _,.___ �f--�-��=-�-------------------------------------------- ----------------------- --�---: Phone ______.___,_----------------------- Address ----- Contractor's Name -- ---�_!.'r--_-_� ��-__________________________-_•_.. license #�� ,�� Phone Installation will serve: Residence [;5 Apartment House❑ Commercial.❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- �/ f Number of living units:___ _-___ Number of bedrooms ___. Garbage Grinder /1/C_ Lot Size _C _C_ :_ _ - ✓:_____ Water Supply: Public System and name ______________________ _________Private �c ----------------------•------------- Character of soil to a depth of 3.feet: 'Sand'❑ Silt❑ Clay ❑ 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 PA Size�___ � 1., �pth '� ---------------- Liquid Dey -------------------- Capacity �sType �l��C� ! Ma#erialjl'=�fNo. Compartments _=.............. Distance to nearest: Wella________________ -_F'oundation _ -_-______�______ Prop. Line .~___ LEACHING LINE f/ No. of Lines ^ --- - -------------- Length of%each line_-f�/_�f__- ---------- Total length Z 'D' Box l-G�' Type Filter Material/� r,1_A p �- / e th Filter Material �------------------------------------- Distance to nearest: Well __tom__(%______-_---_ foundation _ .+. . _______ Property Line Xz_,Z_�___._.... SEEPAGE PITcf� Depth j - ~f____ Diameter ��_. Number ____ Rock Filled Yes No //� r. Wafter Table Depth ----- �- -- --------------------------------Rock Size/ `--`- ----•----•------- f i r Distance to nearest: Well ___ ___ _�_____ ___ ___Foundation _/ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) -------------------------------------------------- ---------------------------------------------------------- .-• Disposal Field (Specify Requirements) ----------------------- ------------------------------------------------------------------------------------------------------------- d -------------------------------- - - - - - ---------------------------------------------------- - --- -------------------------------------------------------------- (Draw 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. 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 BY _' W, �' U -------------------------- Title -------L��Z: (If of er fihan owner) 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --A!, - DATE /F 7l ------- BUILDING PERMIT ISSUED ----------------------- -------DATE ------------------------------------- ADDITIONAL COMMENTS ------------------------------------------------------------------------- ------------------- --------------------------- -------------------------------------------------------------------- ----•- ------------------------------------ --------------------------------------------------------------------------- Final Inspection by: ---- -- ------------------ ------- ---------------------bate F, SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M y .