68-518 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No j a :12 (Complete in Triplicate) [ Date issued ----- --------------------------- ------ This Permit Expires 1 Year From Date issued 2za _05 or a rmit to construct and l the work herein Application is hereby made to the ern compliance lian� ealth e wical th Cou iDistrict inar e No. 5.49 and existing Rules tand Regulations. described. This application is mad per, , + _CENSUS TRACT TRACT --------------- ---------- Jol3 ADDRESS/LOCA ION .�! _ ------ ?� Phone1 � �A rv�� ------- ------- Owner's Name --- - --------------------- - ------------- City -I Address -- -- Phone !- 1� -�i•�.. 9 License # . Contractor's Name ^ Installation will serve: Residence ❑ Apartment House F1 Commercial ❑Trailer Court i❑ Motel ❑ Other -------------------------------------------- I Garba e Grinder -------- -- Lot Size 5� �— ------------- Water Supply: Public System and name _Number of living units:---1.------ Number of bedrooms -- ----- � -- private ---- --------------------------- ------------------------------ _-------------- --- Clay Loam El of soil to a depth of 3 feet: Sand'21I C] Clay E] Peat j—] SandyLoam ❑ Y type ---------------------------- Hardpan ❑ Adobe'❑ Fill Material ............ i yes, p buildings, etc. must be placed an reverse side.) k (Plot plan, showing size of lot, location of system in relation to wells, \ permitted '+f public sewer is available within 200 feet,) je NEW INSTALLATION: (No septic tank or seepage pit P P I r ---__ p' PACKAGE TREATMENT [ ] SEPTIC TANK Size_'i�--�,�,/� �-------- PACKAGE ------ ------ - Liquid Depth - -- - �- - N � - No. Compartments __---1-�-------------- w Capacity dYJ TYPe .-_- Material .�'�s�- E l Prop. Line __.��---•------- V/ --------Foundation ----��- Distance to nearest: Well .l-,��------ - - --"- _- Total Length ----------- LEACHING LUNE [ ] No. of Lines --------- - - ---------- Length of each line_----__-.-- ,i li e th Filter Material -- -- --------------------------------'-- D' Box --_ ------ Type Filter Mater fal P r Line ----------- it Foundation --- d-------------- Property Distance to nearest: Well ___. - --------- l J Rock Filed Yes ❑ No 0,_Y�4} Diameter Number ------------------- R- SEEPAGE PIT [ ) Depth -- ------------- ---------------- Water Table Depth - ----- ----- ------ ------------ - - Rock Size -------------------------------- Distance to -------------------- Prop. Line -----•------- - to nearest: Well --------------------------------- ---- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----- ----------------------------- Date - - -- -------------------------------------------- ) -------- ------C - ------------- --------------- m ---------- - Septic Tank (Specify Requirements .__------------------------------------------------------ ---�- - ____• ______________� � } Disposal Field (Specify Requirements) ------------------------------------------------------------------------ ----------------- fff ------ -------------------------------------------- ------------ -------------- -------------- K ----------------- - (Draw existing and required addition on reverse side) rk will be ce h San uin k: I hereby certify that I-have prepared this applicationRegulationsd that the San Joaquin LocalioHealth D strne in c t nHometowner or loan County Ordinances, State Laws, and Rules and 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 becomes subject W kman's Compensation la sof California." Owner Signed _ ------ - Title - -- ------ --- - -------------- ------------------------------------- By --- -- -- By (1f othe than o er) /17 FOR .DEPARTMENT USE ONLY / DATE --------- - ------------- APPLICATION ACCEPTED BY - - ---------- ------------------- ---------; DATE -------- ---- ------- -------------_..-. BUILDING PERMIT ISSUED .--- ---- -- '$ -- --------------- ---- -- --------- ----------------------- ADDITIONAL COMMENTS -------- ' ------- _. - -- --- - ------------i '-`- - - ---- -- ----------- ---------` - -- -------------- ; - - - = ----- f� : 4 ate -..._- -- ---- Final Inspection by: -- -- ----- N JOAQUIN LOCAL HEALTH DISTRICT j E. H. 9 1-'68 Rev. 5M