70-471 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ('y �, APPLICATION FO \ SANITATION PERMIT 4 ------- Permit No: _. 0 7T__ (Complete in Triplicate) --------------------------------------------------- Date Issued -------------------- -_--- ------------_---- - This Permit Expires ] 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 Rules and Regulations: , •� - -------------CENSUS TRACT -_-- _-' • 'C�fc, ' JOB ADDRESS/LOCATION . •�.6---7-,�� ----.-------�---� ------------ Owner's Name1�_U----� ��: - _r �✓C/t--------------------------------- ----------- - -------------------Phone -- -----------------------••-------- Address ----------- �4 --As--3•------------------------------------------------- City �sC��-------------------------------------------------••-- Contractor's Name _.----------5ez��-------- ------------------------------ ----------License # ------------------------- Phone ------------------------------ Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court i❑ Motel ❑ Other ------------------------------------------- Number of living units:-.-)------- Number of bedrooms __Z----Garbage Grinder _�-Q___ Lot Size _____2 ----------------- Water Supply: Public System and name --------------------------------------------------------------------------------------------------- Private _ Character of soil to a depth of 3 feet: Sand'❑ ❑ Clay F] Peat ElSandy Loam ❑ Clay Loam Hardpan 5W 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) v1 PACKAGE TREATMENT { ] SEPTIC TANK'[ Size---J __� - -`�"S----------- Liquid Depth -----�l-�h. _ V I Capacity __7.' -,.-_ Typ�l------ Material__ uC No !Compartments -_Z.-1.......- . istance to nearest: Well _-_C_512- ----------------------Foundation -->��__________ Prop. Line __`•5---------------- LEACHING LINE [ No. of Lines ---I------------------ Length of each line---_-jC3�---=__ Total -Length ,-__�Ol�------ --------- 'D' Box aVe9____ Type Filter Materiae Depth Filter Material --------- -----------------_---- Distance to ____ ___________Distanceto nearest: Well J --l___________- Foundation --------------- Property Line ----------------- SEEPAGE PIT [ ] Depth�,Yf -'___ Diameter ________________ Number ---------/.----------------- Rock Filled Yes :e—No 0 Water Table Depth ------------------ -----------------------------Rock Size -------`_-------- ----- Distance to nearest: Well ------ Ga_�--------------------- --Found � ation ------- -------- Prop. Line ------`-'..._...-_.._. REPAIR/ADDITION(Prev. Sanitation Permit# ------- ------------------------------------ Dat§ __-- ---------•-••-------- -----) Septic Tank (Specify Requirements) ---- --- - ----- ----------"=----------------------------------------------------------------------- Disposal Field (Specify Requirements) ---------------'-------------------------------------- -------------------------------------------------------------------------------- --------------------------------------------------------------------------------- -------------------------- ---- --------------------------------------------------------- ----------- ----------------------------------------------------------------------------------------------------- _ (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 as to beccoom lett to rk an's Compensation laws of California." Signed - --- ` Owner - - - - - ----------------------- -- Title -------------- ------ ------------------------ (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ------- - -- ------------------ -----. DATE ------ P�-- r �� 7 ----------- BUILDING PERMIT ISSUED ` $ ------DATE -------- -------•------------------- ------ ADDITIONAL COMMENTS �1d`?g "' /17- -'� }rJIG dk � ------------------------------------------------------------------------ --------------------------------------- - --------- --------------- - - - -------- - -------------------- - - ---------- ------------------------------ ---- - ----- Final Inspection b ---- ----" - _'. Date _....- '-' � + SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6B Rev. 5M,