71-354 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No = "`------------- This Permit Expires Z Year From Date issued Date Issued .A J�_~7f_ 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 Rules and Regulations: JOB ADDRESS/LOCATION --------- ----------- ------CENSUS TRACT ------------ ------------- Owner's Name - _ ��/ f�/ --------------- --- ------Phone -------------------- Address ------ ------ ----------------------------------- -- ---------------_ . City ---51" I2 / Contractor's Name .�iS. C_ Ljj'f �G� ------- ---------- ------License # ---- Phone ------ ------------•- Installation will serve: Res idencen.Apartment House❑ Commercial :❑Trailer Court i❑ - ------------------------ - Motel ❑ Other ----------- Number of living units:--(/------- Number of bedrooms _ ----- are Grinder -___U t Gbo 9 ---- - Lot Size ------��-----------------------•- Water Supply: Public System and name ----------------------- -- - -------•-- ----------- ------------ ----------••--------- - _ Private." Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay ElPeat ElSandy LoamClay Loom .0 Hardpan ❑ Adobe [] Fill Material ------------ If yes, type ---------------------------- 1 (Plot plan, showing size of lot, location 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,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size_______ _____ ---- ----------------------- Liquid Depth -------0-------------_--- Capacity -------------------- Type -------------------- Material---------------------- No. Compartments -----------•- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line --------------------_- LEACHIING LINE [ ] No. of Lines ------------ Length of each line------------------------- Total Length -" 'D' Box .---------_.Type Filter Material --------------------Depth Filter Material ------ -_--_--- --------------------- Distance to to nearest: Well --------------------- Foundation ---------------___----_ `- Property line ------------------•-•_-- SEEPAGE PIT [ ) Depth ------------ ------- Diameter ---------------. Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth --------- Rock Size -------------------------------- Distance to nearest: Weil -------------------------------------- -Foundation -------------------- Prop. Line .------------------ REPAIR/ADDITION(Prev. Sanitation Permit=# --------------- ---------- Date ------_--------.---,--____ ] Septic: Tank (Specify Requirements) ------------ ------_. Disposal Field (Specify Requirements) _ a--_ - �'fi -___ � �'� - (Draw existing-'a n-drequired 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 t 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 as to become subject to Workman's/Comensation laws of California." Signed -.- _ Owner ---------------------------------- BY ----- ----- -- -- ---- --- -- -- -- ------------- ------------ Title ---------- -- ot a owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___ __ _______________ - ---------------- DATE PERMIT ISSUED ------- -------- - --- - -------------------------------------- -------------- --- DATE ITIONAL COMMENTS --------- ---------------------- -----------------------------------------------0---------------0----------------------------- ---------------------------------- - - - --Final Inspection by: ---------------------- ----------------------------------- -------- e E. H. 9 1-'68 Rev. 5M i