65-656 - Laserfiche WebLink

Home Browse Search

FOR ol!F 4E USS APPLICATION FOR SANITATION PERMIT z Permit No. -- ��—� (Complete in Triplicate) ------ -v -,- ' - - � _-° Date Issued _-- --'---- --'�-� -----------_-_---- ------ -- _----__-----_-______ This Permit Expires 1 Year From Date Issue . 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 ex'stin Rules and Regulations: �'""'' �I I `� ----�-�--n -r'------ 'J--' -----CENSUS TRACT ---------- -------------- 0 -- ---- , JOB ADDRESS/LOC TIOA1!LG --_/ -- ------ t Owner's Name - ------ hone -- - ------------------------------ --------- -- Address W' l�E ----. City _f -- ------------------•------------- -----------• ---._ Contractor's Name dL --- --=+� L1L�- --------le_ Licensee------- Phone ---- ------ --------- - - J Installation will serve: Residence Apartment House ❑ Commercial :❑Trailer Court i❑ Motel ❑ Other -------------------------------------------- Number of living units;..__,---- Number of bedrooms -i�------Garbage Grinder k,�---- Lot Size ee,50-4?c --------------------- 0 Water Supply: Public System and name ------------------------------------------------------- -------------- ------------ ------------------------ -Private Q Character of soil to a depth of 3 feet: Sand'❑ Slit El 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',/ Size__Via?Ola-- -------------------------- Liquid Depth ...�IK-------------- Capacity /��O-------- Type � Material. i_ "� No. Compartments ---A----_-------- Distance to nearest: Well -----Jap-/---------------------Foundation ...LU---------.--- Prop. Line ---`?-- .-.------- LEACHING LINE [V✓ No. of lines .-_--_,j--------------- Length of each line-------�"1O-------------- Total Length �� ----------- 'D' Box ---I_____.. Type Filter Material A-&--------Depth Filter Material -------19------------------------------- Distance to nearest: Well ..: D............... Foundation --�---------- ----- Property Line ---r--------•----- SEEPAGE PIT [ ] Depth ------------------- Diameter ---------------- Number ------ --------------------- Rock Filled Yes ❑ No 0 - Water Table Depth -------------------Rock Size -------------------- ----------- Distance to nearest: Well ......................... ---------------Foundation -------------------- Prop. Line ---------------•-- REPAIR/ADDITION(Prey. Sanitation Permit# -------------------------------------------- Date --_--------._.._.--.--------------} Septic Tank (Specify Requirements) -- ----------------------------------------------1 ;----------------------------------------------------------------------------- Disposal Field {Specify Requirements) ? ------ -------------------------- ---------------------------------------------------- ------------------------------------------------ ----------------------------------- (Draw existing and 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 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 be a subie o Wor an' ompensati._� lawVof California." Sign d - :... "�` ------ Owner BY / -- - ------ ------------ ------------ Title --- -- --------------- ---------------------- -- - (I other than owner), FOR,DEPARTMENT USE ONLY APPLICATION ACCEPTED -- ------ -- ----- --------------------------------------------- ---------------- DATE -... --~---/-- ---- --------------- BUILDING ------ - BUILDINGPERMIT ISSU ._._ --------- - -------- -_-DATE ------------------------------------------- ADDITIONAL ------- ----------------------------------ADDITIONAL COMMEN S .. - ----------------------------------------- --------------------- --------- -------- --------------------- - --------------- ---------------------------------------- ---------------- ------ ------------------ -------------- -------------------------------- --- - ---- /. Final Inspection by. . Date --- _` " -- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M