71-434 - Laserfiche WebLink

Home Browse Search

FOS`OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: ---------- ---------------- This Permit Expires 1 Year From Date Issues! Date L Tse'!rd 0J9 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 existin Rules and Regulations: _ ( �.� .✓ 4 JOB ADDRESS/LOCATION _l� -�f>✓.a�,�„�;, �� - �/� �" cu,sC �+ r��[u` �r CENSUS TRACT - -� Owner's Name n ods'_o - ------------------------ --------------- --- / Phone --------------------- ------- ------ Address �'�-1- -.1�-Q._1.._p�,�-r�a�-�1YC�f_--- - - � __ City -_ (x l� ---- ----- P7 - ----------------------- Contractor's Name ---__. �, --'�--- ---------License # Y��,�� Phone ----------------- Installation will serve: Reside cn e ❑Apartment House❑ Commercial 2fraifer Court ❑ 4 Motel ❑ Other -- ----------------------------------------- Number of livin i meg„units:_"___-_-__- Number of bedrooms ------------Garbage Grinder ------------ Lot Size Water Supply: Public System and name _---_----_ - - - - - - --- - -- ---- ----- - Private ©� Character of soil to a depth of 3 feet: Sand Silt❑ pa-y .❑ Peat❑ Sandy Lo-am- -❑------Clay 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.l NEW INSTALLATION: fNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) { PACKAGE TREATMENT e [ ] SEPTIC TANK Size- ----- Liquid Depth ---- --------------------- ----- ;1 Capacity ------------------- T Material---------------------- No. Compartments ----------- Distance to nearest: Welle -------------- ----------L- '- ----Foundation --='------ ------------ Prop. Line LEACHING LINE [ I No. of Line ,.:, s _------____ � .----- TyA '= --Depth. Ma' Total Length D' Bax ._---" e Filter Materia! - Filter ------------- Length of each"line--------------------- ------ -_-- __-- �� terial Distance to,neares`'Wel! '-r-------------------- Foundation ---------------- __��Property_Line SEEPAGE PIT [ ] Depth Diameter r l ❑ -------- p = Number ---- - Rock Filled Yes No ❑ Water Table Depth .___:-----= - t € ---------------Rock Size ------` ` ; f" Distance to nearest:Well;..--__ --------------------------------Foundation ---- ------;Prop. Line ----------------- REPAIR/ADDITION(Prev. Sanitation Permit# - Date ) , --Septic Tank (Specify Requirements). --___ } } - ---- --- �? f -------- - ----------- ---------= ---------------------------------- ,Disposal Field (Specify Re:quirements) _----" ___"."-__-- ".---------------- - - -------------------._-------------- �,� ------==----------------------------- { ----------- ---- - ----------------------------------- - (Draw existi x, _ --------------------------------------------------- ng-and required addition on reverse side)l f I hereby certify that I have prepared this application and that the work will be done-in--accordance with San Joaquin w 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 spanner as to become subject to Workman's Compensation laws of California." Signed yih ------------- Owner =------ - BY ------ - --- ---------- --------------- Title ------ --------- - - - - -- - ---- (Ioter than owned ------------------- FOR DEPARTMENT USE. ONLY APPLICATION ACCEPTED BY ---r-------- �- BUILDING-PERMlT.ISSUED== .=== —"= = -------- DATE -.__ :7 ------Jl ........... ..— I ADDITIONAL COMMENTS ----�-- ---=- ------- -------- -- _ _ p= --------------------------------- ------------•------- -- -..__. "---------------------------------------------.---------_-----_--•-__--------------__--------------.--------_-_-------------------.--_-------------------------------_------------------------- - --•-------- '-'- ----- ------------ ---------------------------------- -e----�---- - ---------------------- ---- - -----JFinal Inspection b - ---- ---------- ---- •---- ----------- at -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M