SR0085543 - Laserfiche WebLink

Home Browse Search

mon vrrmc voc: APPLICATION FOR SANITATION PERMIT / (Complete In Triplicate) Permit No...%..6.:.J...... .............................................. Date Issued This Permit Expires f Year From Date Issued .................... Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work hereln described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC ION ....45.. . X) � .-- .. ............... ..........CENSUS TRACT .......................... Owner's Name .. _.... ��...... �� l Phone .. ... . ........................ Address �.�._. �_.%..................... City .R�-t^rs�*� ...'v _. .......................... ��.. . i.. i Contractor's Name .._. ' -----..License 991 %8�.f1-... Phone .............................. Installation will serve: Residence ❑ Apartment House C] Commercial ❑Trailer Court ❑ Motel Q Other ..._ %'/. - .-------- Number . ---Number of living units ------------- Number of bedrooms ............ Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name ............................................. ........... ................. ................. .- .. ........Private Character of sail to a depth of 3 feet: Sand 0 Silt ❑ Clay ❑ Peat ❑ Sandy Loam fZ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Mnterlal ............ If yet, 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 of seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK j ] Size ............................ ........... ...... Liquid Depth ............. ............. ks .. Capacity ................... Type _................... Material............ __ No. Compartments Distance to nearest: Well _______________ ............... ...Foundation ....._............ Prop. Line ..................... LEACHING LINE: (] No, of Lines ----------------------- Length of each line Total Length ............................ 'D' Box .........--- Type Filter Material ....................Depth Filter Material ------- ......... __....-__.......... ti»..' Distance to nearest. Well ........................ foundation Property Line ............... ___._ f SEEPAGE PIT [ ] Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No Water Table Depth .. ...........•............_..---------•-----.-Rock Size ................................ Distance to neareit: Well ...» .._.».»____ ..................Foundation ......... ... ...... Prop. Line ......................� REPAIR/ADDITION IPrev. Sanitation Permit #............ ..----- _---------- _----------- Date .................................. Septic Tank (Specify Requirements) - �/�e .-.r_ ...... ».r .._.......... ......................._-___ ........ _........._....... Disposal Field (Specify Requirements) .GCS.. --- __A/ _ ........ .-..._ . ---- _. __.._......... ._................................_,_....__....._..............___........_............................._................................................... ..... ... ............................. (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, Son Joaquin Local Health District. Home owner or Men - 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 porton In such manner as to become subject to Workman's Compensation laws of California." Signed...._..............._.........._.....--•--._.........................._ Owner By............................................................... Title _._...................... .......... ...... ... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..._ :.... . „ .„ . DATE / -�� ...% .. ....... BUILDINGPERMIT ISSUED ........ ........ _......... _................... .:.._._________...._ ... ,.._........._.._.......DATE ........._.................. ». ADDITIONALCOMMENTS .......................................... »................... ................. ... ...... ......._..... ........ _..»»... ..................... ................ --..... .._.......__..__......_..._...._.__»._....._... _... ......... »..» _._...-..._.-.__... »..._..............._......._. -•... .-••••-......... ._••••--•_...._.. ) finol Inspection by: -- ....... .............. ............................ »...._.... Date / / )`.......... .. EH 13 2h 1-68 fiev. 561 SAN JOAQUIN LOCAL HEALTH DISTRICT / 8/711 3M