70-25 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. �5---- ------ ------ ----------- ------------------ -------- .r_ .. (Complete in Triplicate) Date Issued (-/.�-n-70 This Permit Expires 1 Year From Date Issue ----- work herein1 Application is hereby made to the San Joaquin ian ecal wiHh Counealth Dtytrict Ord Warne No. 549 and ex st g Rulesermit to construct and talndhRegulations: described. This application is made, p01 ! �� - --------- CENSUS TRACT --- 2,0 --- JOB ADDRESS/LOCATIO. �- ,r' ! --------------- - ----.-Phone _.---------------------------------- 0 - -----. ------------- ----- Owner's Name ---------- --------------- - e --------------------------------- Address ------------------------- j ". -- �� 1 V Contractor's Name � `�----- ------ L --.License #/_� �" Phone _.�-(d_ •+ - Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ,❑ Motel ❑Other ------ ----------- ------------------------ �_--.- Nu'Imber of bedrooms .3-------Garbage Grinder __.I _---- Lot Size ----�� "-r----- Number of living units:-.__."- - ------" ----Private Water Supply: Public System and name ------------------------------------------ -------------------------- ------------------------------- Peat Sand Loam -[] Clay Loam Character of soil to a depth of 3 feet: Sand❑ Sift❑ Clay ❑ ❑ Y � Hardpan' Adobe ❑ Fill Material If yes,type -------------------------- j1t (Plo't plan, showing.size-of.'lo, location of system in relation to we11s, buildings, .etc. must be placed on reverse it ermitted if public sewer is available within 200 feet,) NEW INSTALLATION:— septic ta`nk�r seepage p' p ..._=� " Size--- ----------------- -------- ------ -----• liquid Depth ---------------------.---•- � PACKAGE•.TREATMENT[-]•--SEPTIC TANK![.]= °-� x- �t Material-'------------------ No. Compartments _--------4•-•------- Ca acifi TYPe -------- v p Y�F----- ---- f Distance to nearest: Wel( ---------'------ --- -------_-Foundation ---------------------- Prop. Line _-------- Total Len th --------------1 C ------ Len th .of,each line--------=------------ --- g LEACHING LINE-w.[,] No. of Lines _--�--------- -- g 'D'.,Box -_-.-------- TYPe Filter Material ------ -------------Depth Filter Material -.------------------------------ - _ ' Foundation Property Line --- ------------- •_-- Distance'to nearest: Well -----""---- -- -- --------------------- -- i "� Rock Filled Yes ❑ No SEEPAGE PIT [ 1 Depth -- - Diameter Number ----------------------- -----Rock Size '. Water Table Depth - ---------------- --------------------- - Distance to nearest: Well ----------------------------------------Foundation Prop. Line --------------_------ ' -------------------------------------------- Date -- ------ ----------------------- - ---------- REPAIR/ADDITION(Prev. Sanitation Permit _------- -�------ - I Septic Tank (Specify Requirements) --------------------------- --------------- ---r-- ----- Disposal Field {Specify Requirlements) --- C -•6 =3 �� ` -- ------ --- ---- -- - -------------------------------------------------------------------------------------------- - i -------------------- ------------------- --------------------- - -----------4-------------------------------------------------------- ------- - i (Draw existing and required addition�n reverse side} E I hereby certify that I have prepared this application and that the fw rk will be done in accordance with San Joaquin { County Ordinances, State Laws,'and Rules and Regulations of the can Joaquin Local Health District. Home owner or licen- f sed agents signature certifiesthe following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Owner Signed �. eo " -------------- c ---- --- -------- BY ------------ - Title ---------------------- -----------than owner) I` I FOR DEPA MENT USE ONLY r. ! DATE ( APPLICATION ACCEPTED BY ._-- '- •¢ -p-- -�------- BUILDING PERMIT ISSUED --------1--------------- ------------------ I------------------- ----------------------=---- DATE ADDITIONAL COMMENTS --------- --�---__-- ----------------------------- -----R a-------- -� ----- -. ,r ------------------------------------------ - _ _ __ - ------------------------------- �. - --- ---- ---- Date -- /------- ------ - ---------- ---------- I Inspection by: `- SAN JOAQUIN LOCAL HEALTH DISTRICT ' f . E. H. 9 1-'b$ Rev. 5M.