70-61 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT �� U �----------- ------ Permit No. -- -- ------- -------------- (Complete in Triplicate) T '/ -- ------------------------ -- Date Issu.,�,-7d--- -...- sued : -------------------------------- i --------------------- ------------------------- - This Permit Expires 1 Year From ate s Application is hereby made to the S'an Joaquin Local Health District for a permit to construct and install the work herein j described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: T� a JOB ADDRESS/LOCATI N . V- ------------ --CE=NSUS TRACT t ------- ----------- Owner's Name -- -- -I�l�e�'."-C,r-��1�-��-- --------------------------------------- ------Phone- r ' Address ------------ � �- ------- -------- city _L .T� � Contractor's Name - ----- ` --------------------------------- License # -------------- Phone ` Installation will serve: Residence ❑Apartment House F1 Commercial [:]Trailer Court !�� Motel ❑ Other ------------------------------------------- Number of living units:--- ------- Number of bedrooms -,-�-------Garbage Grinder "._ _ Lot Size - J _�C ". Water Supply: Public System and name --------------------------- Private ffr tSand Peat Clay Loam:[] Character of soil to a depth of 3 feet: Sand'�ilt❑ Clay ❑ ❑ Y 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: INo septic tank or seepage pit permitted if public sewer-is available within 200 feet,) PACKAGE TREATMENT A [.] -SEPTIC TANK [+< ' Size" .Xy--?l1La-------'-------- Liquid Depth ------j��,---:--- 2 Capacity '/ ___„- YP QQ Material_ Gr� �r No. Compartments ---------------------- ” T eY�+�� =-- ` i :"Foixidation " ------------ Prop. Line --'We---------- Dista �C'------- Total Length /. --------- Distance to nearest: Well �_ ___-- No. of Lines eac l'�ne __- _ LEACHING LINE [t� f --- i • �I 'D'•. Bo`x Type Filter Material - ".`�Qepth Filt&` Material _____.-__ -�. - ----`y r. '. --------------- Distance to nearest: Well �a5�r�--- Foundation•L -----=----------- Property Line SEEPAGE PIT L ) Depth -------------------- Diameter- --= ------.Number -------------------------- Rock Filled Yes ❑ N° r❑ j. WaterTable Depth ------------------------------------------- ----Rock Size -------------------------------- IFoundation Prop. Line _ Distance to nearest: Well ----------------------------------- - ----------- Date ----------------------------------). \, REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------y h tit `Septic Tank (Specify Requirements) ------------------ ----- ------ ---------------------- - - I Disposal Field (Specify Requirements) -----------------------------------------4. I �. ------------------------------ nd re aired ad------------------------------.--- - -- dition on reverse side) (Draw existing a required I hereby certify that I have prepared this application and fihiit the work will be done in accordance. with San Joaquin County Ordinances, State Laws,,and Rules and Regulations.of- the San Joaquin Local.Nealth,District. biome owner or licen- sed agents signature certifies-the following: ; w _ r"" _ ' s "I certify that in the performance su of the work for which this permit is issued, I shall not employ any person, in sac manner as to become subject to Workm IS Comp satin laws of California." Signed --- Owner ----------- Title ------------------------------------ ----..----------- (1f other than owner) FOR DEPARTMENT USE ONLY DATE " r�_' ------ APPLICATION ACCEPTED BY ------- -BUILDING .___" - -BUILDING-PERMIT`ISSUED " --�� . ._ -- ------ - --------------'-DATE"__: ------------------------ -- u_za ` "--------------------------- ----------- - ------- ADDITIONAL, COMMENTS --------__`y-/ ' -- ----------------------------- Z - ------------------- ------------------------------- ---- ---------- ------------------------------- - --- ------. -------�-- -- -------------------------------------------------- a Date ---_ - ---------- ------- Final Inspection b - ------------------------ - - SAN JOAQUIN' LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M