72-1047 - Laserfiche WebLink

Home Browse Search

A FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------ -- -------/i, -- ------------------ (Complete in Triplicate) Permit No: .__7 _=� Y7 ---------------------------------------------------------- - -------- --------- ------------------------------------ . ---_----_---------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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---------------- ----------------------------------------------------------------- -------------CENSUS TRACT -----------------•-------- Owner's Name ------ V ?I�� ------aA!?,(. -----------------------------------------=- ------.Phone S�3:72X�}---- Address {�'------s_/- iIC'O�✓ 17!/ City _ _�1/�rG� _ ------------• --•-------------•------ Contractor's Name.----- ------------------- -------License --- Phonec ---�_ ! Installation will serve. 1Residence 0 Apartment House,[:] Commercial ❑Trailer Court .❑ Motel ❑ Other -------------------------------------------- Number of living units:__ ______I Number of bedrooms _________Garbage Grinder ------------ Lot Size ________-__-_____________________________ Water Supply: Public System and name .---------------------•-----•------------------------------------------•---------------------------------------Private Character of soil to a depth of 3 feet: Sandy Silt j] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material _.---------- If yes,type ____________________________ (Plot plan, showing size of lot,11ocation 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,) r PACKAGE TREATMENT [ I SEPTIC TANK f ] /ngthh ________ ___________________._______ ______ Liquid Depth _________________-___,_____ ` Capacity --- --------- ------ Type ---- ---- aterial------------------ --- No. Compartments --------------------•- i ' Distance to nearest: Well ----- ----- -------------Foundat' n ---------------------- Prop. Line -----------.--_--..--- a LEACHING LINE [ ] No. of Lines _______________________ Lf each line--------- ____-_____-_-____ Total Length ,___--_.___.___._______.__-_ ,\ D' Box ------------ Type Filter Ma -------------------De Filter Material --------------------------.__...-----._-__-- Distance to nearest: Wel! _____._ ____ Foundatio _____._____ Property Line _---------______________ I SEEPAGE PIT [ ] -Depth ____--------- ----- Diameter _____ Numbe --_----___________________ Rock Filled Yes '❑ No i❑ Water Table Depth Rock Size i - Distance to nearest: Well _=_________-____-___________________Foundation -------------------- Prop. Line ............ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _-.-_________________:________-___) I CSeptic Tank {Specify Requirements) --------------------------------------------------------------------------------------------------------------••----------_------------------ Disposal ---------•------ '-------- Dis osal FiepecifReuiremePs- _ --- ----------- -------------------- --- --- /7 _ --------�- s -------•---------------------------- --------------------------------------------------- ------------------------ --------------------------------------------------- - -- -- ------------------------------------------------w-------------------------------------------------------------------------------------------- (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,jand 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 become subject to Wo man's Compensation laws of California." Signed ---- --- --- - - -- ----- Owner ----------- --------------- ------------------------------ BY -------- -- — -- -- - -- ---- - - ------- ---- -- -------- -----------j------------------ Title (If other than owner} + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- J--`-:---- - - -_---_---. DATE -----lv-- -`----7 - ------------ --- --- -------------------------------------------------- ---- -- BUILDINGPERMIT ISSUED -------- ------------------------------------------------------------------- -------------- --------------DATE ------------------------------------------- ADDITIONAL COMMENTS __- _____'__________________ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------- ----------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------------- Fina! Inspection b Date --`fr' ' y 2-�--------- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M F �3