70-235 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: �� APPLICATION FOR SANITATION PERMIT ' Permit No. - - --------------------- ------ (Complete in Trip icate -------------------------- _. Date Issued This Permit Expires 1 Year From Date Issued I -------------------------------------------- - 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 omplian e with C unty Ordinance N 549 and existing Rules and Regulations: JOB ADDRESS/LO N -- - - - ------• ---- CENSUS TRACT ------•---- Owner's Nam - - --------- ------------------:---------------:- P one ------------ ----------------------- ` '�---------- i -- ------•--._.. City -=- ---- - Address ---Ax. ;--- -•-- - - --- ---- Contractor's Name ------ __ _ _ -----.License # - Phone Installation will serve: Residence A rtment House Commercial ❑Trailer Court M ' Motel F71 Other ------------------------------------------------- - --------- --------- -------------- Number of living units:__------- Number of bedrooms---:Garbage Grinder ___________ Lot Size __________________ _ ---------------•-------- Water Supply: Public System and name ----------------------------------- 14.1 _Private Character of soil to a depth of 3 feet: Sand'M Silt Q 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.) W NEW INSTALLATION: (No septic tank or seep a pit permitted -f `blit ewer is available ailable within 200 feet,) PACKAGE TREATMENT 1 ] SEPTIC TANK'j Siz - ----- _ -- -------------- Liquid Depth -------------- .,___-- No. Compartments - -------------- Capacity - -- ` Capacity )--0d Type ----------- ------ Materia . p � HCl Distance to near t: Well ----------�-----------------Founddation -____-�a---------- Prop. Line -------_-7---------- ---------------- LEACHING --------•- ` Length of each line______-0 _ ___ Total Length - ---_.____•-.- LEACHENG LINE [ No. of lines ________ -------------- g --" 'D' Box ___ --____- Type Filter Material ---s_A� ----Depth Filter Material 1 ---------.-------------f-------- 01 Distance o nearest: Well --------�D------ Foundation .----`t -------------- Property Line. ------ --.------•--•:.. SEEPAGE PITDe th Diameter ---------------- Number ______---- ----------------- Rock Filled Yes Q No 0 [ ] p WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------- ---- Prop. Line -------.-------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -____--_____----------------------I i Septic Tank (Specify Requirements) ------------------ ----------- ---- ----'---------------------- ------ -----------------.._--. Disposal Field (Specify Requirements) -------------------------------- --- - ----------- ------------------------------------------- - - --------- - ------ ---------------------------------------------=------------------------ ---------------- -------- ---- --- - - - ---an ------- --_ _ _: - _ (Draw existing d 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 Rules and Regulations of the San Joaquin Local Health District. Home owner at licen- sed agents signature certifiespe e following: "I certify that in the perfor a I of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to W rk 1,'s Compe fT do .laws of California._" Signed ------------------------------ --- Owner Title l (If other than wner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED- BY . =_" x _. '� -_------"' -- " ------ DATE -------- BUILDING PERMIT ISSUED - ----------DATE ADDITIONAL COMMENTS--------------------------------------------------------------= - -------- ------------------ = - - - -------------------- -------------- ------------------ ------------------------------ - ------------------------------------- ---------- ------ ------------- a ' ---------------------------------- ---------i -------------------------------------------------- ------------------------------------------- '.'� ---- � .: �, 7I Final inspection b — ----------------------- = Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M.