69-1015 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: . APPLICATION FOR SANITATION PERMIT ------------------------------------------------------ Permit No. - �6)v -------------------------------------- (Complete in Triplicate) �Z_ 5 Date Issued/,X- ,:5 This Permit Expires I 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 Mules and Regulations. JOB' ADDRESS/LOCATION . .._-i air _-- -- -- - --- .------------=-CENSUS TRACT -------------------------- - ---------------------- - Owner's Name - - `' �.`'' ---- -----------Phone ------ 7---- - Address -------------1 --- a------ Cit Contractor's Name r �-�---- -4�-- ----- .License # _-�� 3 8_ - Phone i Installation will serve: Residence Apartment House❑ Commercial : Trailer Court 10 t Mote! ❑Other -_._ Number of living units:-.__- ----- Number of bedrooms �_3-------Garbage Grinder -----V--._ Lot Size ---- - - --'-__-___: Water Supply: Public System and name ------------------------------------ --- -----------7---------------------------------------------------------Private [ I Character of soil to a depth of 3 feet: Sand'❑ Silt❑ _Clay ❑` Peat❑ Sandy Loam Fj 'Clay Loam ❑ Hardpan ❑ Adobe '❑ Fill Material ------------ If yes, type .__.-______________________ (Plot plan, showing 'size of lot, location of system in relation to wells, buildings, etc.-mbst-be•placed'on"reverse side.) ' NEW INSTALLATION: (No septic tank or seeps pit permitted Vif public sewer-is available within 200 feet,) � `ter PACKAGE TREATMENT f ] SEPTIC TANK [ Size��JCQ_,�L ________________ Liquid Depth -----I/---------------- - a [ i Capacity _�_ 'a�_ a._. _ Type _ Material, --- - No. Compartments --------------------- Distance to nearest: Wel! .------ `'---"` ---------Foundation ------(A---------- Prop. Line ----5--------------- LEACHING LINE [,,/No. of Lines ___._ ------------ Length of each line- `-------.------ Total Length _Q `f°__--___ ' D' Box __ _-.-_ Type Filter Material _/�„____Depth Filter Material -._-f 4__ _____________________________ i Distance to nearest: Well ---------4`p......... Fovndation AV-�'� ___ Property Line ----------I- ._.__.__ _ \1 SEEPAGE PIT.- 11 Depth ____________________ Diameter ---------------- Number .-- __._..__ -------- Rock Filled Yes No 0 t 'w Water Table Depth ----------------------------------------- _______Rock Size'__________ ___________________ l � 1, Distance to nearest: Well ----------------------------------------Foundation -----_=------------- Prop. Line -------------------_- �� I REPAIR/ADDITION(Prev. Sanitation Permit# ----------_------------------_____--"'=__ Date ------- _________________________I Septic Tank (specify Requirements) - :` Disposal `Field {Specify Requirements) ------------ - - -----------------------:------- ----------------------------------------------- --------------- -------- --------------------------`r---------------------------------------------------------------------------------- ----------------------------------------------------------=------------------------ -- f F (Draw existing and required addition on reverse side) I hereby certify that 1 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 y as to become subject to Workman's Compensation laws of California." Signed ----------------------- Owner BY t------------------------= --- -----°-w- -,lJ " Title �-i41�r< ers�L --- ---- r (If other than owner) FOR DEPAIRTM'ENT USE ONLY APPLICATION ACCEPTED BYDATE _L. ' '. ----------- BUILDING PERMIT ISSUED -------------- ------- - ----------' --DATE ---------------------- - -----------------� ------ -------------------- ADDITIONAL COMMENTS ---- ----------------------------------------------�------------------------- ----------------------------------------------------------------- ----- --------------------' f� - - f Final Inspection by: -- - - - --------- - - --------�------------ ---•---------------------------------- Date ' -�. _ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M