74-1061 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..................•• -..f......................................... ...... : (Complete in Triplicate) . ................................... . , - Date Issued ....:"............. ................... .......... •-•- This Permit Expires 1 Year From Date Issued Application is hereby, mode to the San Joaquin Local Health District for a permit to construct and install the work herei n described. This application is made in compliance wit County Ordinance No. 549 and existing Rules and Regulation3: ........CENSUS TRACT ...................:...... JOB ADDRESS/LOCATION ... ..... ........ .. ......_ ......_............... ----- ""�L #— YLfC- Owner's Name -----..,..... ............................ ---- -• - •�-•- -----•-----...........--........Phone ................. ......... (/ ..... Address - -. -- I -City .....-... ; ''r '"1��,f Contractor's Name . , .License # t......._ . ...... Phone .................. installation will serve: Residence.❑ Apartment House❑ Commercial []Trailer Court �] r Mote! ❑ Other AM !bl ---- _ Number of livingunits:...._.-.... Number of bedrooms - -4, --- -•Garbage 'Grin der ... 'Lot Size :_.................................__...... � g ` 1NijteF Supply: Public System and name".-....` .�..:. ice. I CI---••L rrva .� _ P ' to r Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ feat❑ Sandy Loam ❑ ay Loam ❑ . I 4 Hardpan ❑ A obe ❑ X type FSI{ Material.------�-... If es, e ......:.... ................. k (Plot plan, showing size of lot, location of system in relation to well`s, buildings, etc. must be placed on reverse side.) NEW.INSTALLATION: (No septic tank or seepage pit permitted if puljlic "sewer is available within 200 feet,} q�� i l9�J i Liquid Depth --------- ................. . PACKAGE TREATMENT ] I SEPTIC TANK } Size......°, -•-- : ---.... �,-: Capacity .. , Type . ....--•- Material.Y................ ... No. Compartments .-- •--•-..... . i p k Distance to nearest: Well ---Foundation ....: ....:.......... Prop. Line ----_--------..._.._.. ti ] 3 alength of each line.i��✓ ......-• _.. .;: Total Length ��f•--.._....... LEACHING LINE ( J No. of Lines ( I } E I. _ Depth Filte Material .F. ......... ........................ 'D' Box -$ Type Filter Material _.._�.__-- --�-•- ,.�,. , . Property Line Distance to nearest: Well .. p tY lS Rock Filled Yes ❑ No Q SEEPAGE PIT [ ] Depth . Diameter ---•----.....Nurnbe; ..., s h , #. Water Table Depth - Rock Size . ----------•-•---------� - 3;., undation --• Prop. line ........:............. Distance to nearest: Well ---- ------------- ---•--•-- -•----• Fok REPAIR/ADDITION(Prev. Sanitation.Permit# -------- --------- -------------- ------ Date ..._.-- -----) ti Septic Tank (Specify Requirements) ......... ----------•----------------. .----•--- ---....V.............- --------- ...........-------- i 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: " r which this permit is issued, I shall not employ any person in such manner I certify that in the performance of the work fo as to become subject to Workman's Compensation laws of California." Signed . .. ...:.................. ... Owner''. I r6 `. Title . ..�....... ... .... . ....._..................... .. ........... ° ------ _... (If other than owner) r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY A ._. _ DATE ....... ...........y. I -_. ....- ........... --..-- ---..:._..DATE .............. . - - BUILDING PERMIT ISSUED . [ . ADDITIONAL COMMENTS ....................... ..... --------------- -------------- ---- - .......... ---------- ................ . ( _____ ------- Date ............. , '. . .. Final Inspection by: ... ...------•---•----------------------• ----• SAN JOAQUlN LOCAL HEALTH DISTRICT 14 7/723, .. .