74-1030 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT !/ 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 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 ..... +i J* .ffrJ� � .f�� ..p... -•................CENSUS TRACT .....57 Owner's Name ...... ....... -------------- ...................... ...................................Phone .................................... Address ..1 ...... city /E? •4 -_....................... Contractor's Name -- -•._ ' ----------•• . .......... Commercial 7�a I�Court Phone /� �u�,�.� - _ License Sf,�1� Installation will serve: ResidenceK Apartment House❑ C ❑ ❑ Motel ❑ Other .._ •----------------- Number of living units:_. ._.. . Number of bedrooms .3.......Garbage Grinder tot Size ....ate...�:-------•••••-----•-• Water Supply: Public System and name .................... -............___..----..................-----------------------.---.Private . 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 ,relationAto wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seep a pit permitted if public sewer is available within 200 feet,) ,r �I PACKAGE TREATMENT [ ] PTICTANK,, Size.... _y/V ._ro....._.... liquid Depth ._ .............. C acct Type j�/REG `' Material.-........... . Y ,� YpNo. Compartments .. 1 ! istance to nearest: Well J�Y'.Q._.-- ••----...-----Foundation v.- Prop. Line .. _.Cl--....__.._. LEACHING LINE No, of Lines . �' I ngth of each line /Q -....... _._. Total Length �........:__. i D' Box .._,?r Type Filter Material ..1 -X��Depth Filter Material ....../.,2'.`�..--.--•--•---•-•-•-----•- Distance to nearest: Well .1.Pf............ Foundation -3.,3-................ 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 --------------.-._--------_..---) Septic Tank (Specify Requirements) . . .................... .................................•---r-------------------- ------•----... .... ........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 ilcen- 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 7ZO�. - By Title .--•................. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... k 0-- -- ..... _............. ... DATE .../ . ` _�. ........ BUILDING PERMIT ISSUED ....... . ..... ..............PATE . ..... ADDITIONALCOMMENTS .................. ... .. . ......... ............... ----- - ----•....-----..........._...-----.......•--....----•------• ... ............••- .-------•--------- ........ . ..... -- ------ -- .. ..._.. ------ •----- - --- `-- Final Inspection by: .._ r.................. ------------Date .. ..... ... . .. ...:_'.... SAN JOAQUIN LOCAL HEALTH DISTRICT �I72 t: H 13 241.'A9 Rev_ SM — ... itiI