71-083 - Laserfiche WebLink

Home Browse Search

FOR OFFICETUSE: APPLICATION FOR SANITATION PERMIT / Permit No, (Complete in Triplicate) ----------------------- --------------------------------- Date Issued ---------------------------------------------- This Permit Expires 1 Year From Date Issued w - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein 5 described. This application is made in compliance w' County O i once No. 49 and existing Rules and Regulations: CENSUS TRACT ______ JOB ADDRESS/LOCATI " Phone Owner's Name ..� � City `- - �- --- --- Address` --------License Phone Contractor's Na Installation will serve: sidencxApartme ouse,❑ Commercial ❑Trailer Court ',❑ Motel ❑Other -------------------------------------------- Number ------------- --------------------------Number of living units:-"/ ---- Number of bedrooms ---.-----Garbage Grinder,,X.f'Lot Size _ ---—------- Private Water Supply: Public System and name ----------------------------------------------------------- --- Character of soil to a depth.of 3 feet: Sand❑ Silt Clay Peat El Sandy Loam f:1Clay Loam E] Hardpan ❑ Adobe'❑ Fill Material ------------ if Yes,type --- ------------------------ JPIot 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------------------------------------------------ Liquid Depth --------------- 0 _ ____--_ No. Compartments ------ --------------- 00 Capacity --- Type ----------------- - Material Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -------------=---• � r / No. of Lines ` _ ___ Length of each ne___-_---��--------- Total Length ----- --------- �A LEACHING LINE [ ] ------{-- ------- g -_Depth Filter a rias -----�Gt-----------------------.--- k .. D' BoxType Filter Material Property Line Distance to nearest: Well Foundation p rty ___-____ Rock Filled Yes No I' SEEPAGE PIT [ ] Depth - ---- Diameter ---------------- Number ----------------- 3 ------------ Water Table Depth ----- Rock Size ----- -------------------------- -------------------------------- 4 Dis#ante to nearest: Well --------------------------------------- -------------------- Prop. Line ------------------ REPAIR/ADDITION(Prev. Sanitation Permit# "------ -------- - A I ------------------------- Date ----------------------------- 1 �I - Septic Tank (Specify Requirements) --------.------------------------------------------------------------------------------------------ - -------------------- 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 t work for which this permit is issued, I shall not employ any person in such manner i as to beco s bject to orkman's nsati.on layfs. of California." Signed --- ---------------- Owner ----- -- ------ ------------ Title ------------------------------ o er an o FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY _-------------------------------------------------- --------- DATE _-D .DATE -------- ---•----------------- ----------- BUILDING PERMIT ISSUED - --- ----- -- - -- ----- -------------- --- ADDITIONAL COMMENTS __c -1 L I�Q r�1 rn ------ - - -- ------------------ ------------ ---------------------=--------- ... --------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- - - --------- ----------------------------------4------------------------------------------------------------- _ , -- ..Date -------- -------- - -- - - ----------------- - - Final Inspection b "--"""-" ! SAN JOAQUIN LOCAL HEALTH DIST CT E. H. 9 1-'6$ Rev. 5M