71-176 - Laserfiche WebLink

Home Browse Search

fv4• x4,r• FOR OFFICE USE: F.-' APPLICATION FOR SANITATION PERMIT --------------- ---- -- ---•- --- ----------- (Complete in Triplicate) * J Permit No ��:17 6' ---------=------------------------------- -------------- Date Issued/a7_/• This Permit Expires 1 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 1 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ~,, J ----CENSUS TRACT .__�5'__--..?. JOB ADDRESS/LOCATIO City..... _Phone Owner's Name _0v�J"_---------------------------------------- Address ......--7 -------- ---- -- ---------------------- Contractor'sName---- - _ ----- - - - 0_ - * License # ------------------- Phone ------------------------_-- Anstallation will' serve: Residence partment House '171 Comme cial : Trailer -Court ,S] fMotel 6 -Other -------------------------------------------- g f'beclroo••ms ___3 _______Garbage Grinder ____------- Lot Size i' Number of living units:___ _-__ ., t Water Su 1 Public System and name ______,_________ Private 9; Number o t Character of soil to a depth of 3 feet: ISand-�� 5ilt ❑ Clay .❑ Peat ❑ Sandy Loam ❑ Clay Loam :[� Hardpan ❑ Adobe'o Fill Material ------------ If yes, type __------------------------- (Piot plan, showing size of lot, location of,,, Y m. -in -relation to wells, buildings, etc. must be placed on reverse side.) i n NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer -.is available within 200 feet,) j PACKAGE TREATMENT [ ] SEPTIC TANK,[ I Size ----------------------------------- •------------ Liquid Depth a — -------------------- Compartments --- -- Material --------- ------ No.Ca Capacity TYPe -.-•- !to neatest: Well ----Foundation ---------------------- Prop. Line --- ••---- 0 . LEACHING LINE [;� No. of .L• +-------------- --- Length of each line--------------------- Total Length Distance +D' Box -------- �=„Type Filter.Materipl -' --------------Depth Filter Material --------------•-------•----.-. _r Distance to nearest: Well ----- t Foundation ------------------------ Property Line----------------•-----� Rock Filled Yes 'El No i❑ P SEEPAGE PIT [A Depth -----------'-----Diameters ----” ----------- Number ------------------------ ! `•-^�- INater Table Depth �------ ----• -------Rock Size ------------------------- - 3 Distance to nearest: Well ------ _"-y-----�--- - ---------------- Foundation ----. ------------- Prop. Line ----- ------- = --- ----- 1 REPAIR/ADDITION (Prev. Sanitation Permit # _.-�-----, ----=------------------- Date __,---------------• - Septic Tank (Specify Requirements) ---- -----------/--- / Disposal Field (Specify Requirements] -�� --- --- -------- - - ------ - fi - _., f raw 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, land R d Regulations of the San Joaquin Local Health District. Home owner or liven - sed agents signature certifies th owing: "I certify thatin the erfor nce of the war for which this permit is issued, I shall not employ any person in such manner ( as to be me subject o W rkma' 6's mpe sation laws of California." t cr-----�---------- Owner Signed'._ ." --------------- ------ ------ ---------------------------- ` t --------------------- Title ----------------- ------------------------------------------ ------ BY . ------------------ ----------------------------------- ( i (If other than owner). ' 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _. -,-- ---- - DATE BUILDING PERMIT ISSUED --------=------ ---------------------------=--------------------------------------- DATE - ------ r ADDITIONAL COMMENTS -------- ---------- ------------------------------------------------------=------------------------ ---------------------------- +--------------- -------------------------------------------------------- + r ----- _ ---------=------- -------------------------------------------------------- - �n t a �/ Final Inspection b Date -______ %� 1 �.� U •------- /� SAN JOAQUIN LOCAL HEALTH DISTRICT h I E. H. 9 1-'68 Rev. 5M.