70-121 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - 7a l - APPLICATION FOR SANITATION PERMIT - ------------------------------------------- (Complete in Triplicate] Permit No. ---------------------------------.------------------------I This Permit Expires ] Year From Date Issued 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: JOB ADDRESS LOCATION .-- _ 1 / _ 3-Q.----: ------ - ------- J ' /lil y------..CENSUS TRACT Owner's Name ------- Phone p +� -- ------ --------- Address - --313 ----- - -- --- ----. City --------- -- ---------------- --- - -- ------------- Contractor's Name --------- -- yt J----------------------License #/CJOa ____- Phone Installation will serve. Residence [Apartment House❑ Commercial ❑Trailer Court Motel ❑ Other l i Number of living units:---_/----- Number of bedrooms _--' Garb a GO der -.-_-_ __ Lo Size ��,� / Water Supply: Public System and name ----------------------------------- -w51, --- ----------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 'D Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill Material ------------ If yes, type ---------------------------- (Plot -(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,) 44 PACKAGE TREATMENT f ] SEPTIC TANK f ] Size----_---------------------------------------------------------------- Liquid Depth ---------_-_----.-_---.-__ fy Capacity -------------------- Type -------------------- Material------------------_ No. Compartments Distance to nearest. Well ------------------------------------Foundation ---------------------- Prop. Line --...-------.:...----- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ----------------------- 'D' ---------_-_ --'D' Box ------------ Type Filter'.Material --------------------- Filter Material -------------------- �•' Distance to nearest: Well----------"------------ Foundation +________________L Property Line ------------------- SEEPAGE ---_---__---_-SEEPAGE PIT [ ] Depth -------------------- Diameter------------ -- Number --------- ------------------ hock Filled Yes C] No i]] Water Table Oeptli-- :----- -----------------------------------Rock Size -----------------------•- Distance to nearest: Well ----------- •---------------------Foundation ------------- ------ Prop. Lime ---------------------- NWAMIADDIFlON(Prev. Sanitation Permit# -------------------------------------------- Date -----------------------•-----___-_) Septic Tank (Specify Requirements) ----------------------------------------------- ------------=------ ;-----;-----------------------------•-------------------------------•-- Dis osal Field (Specify Requirements) -------------- P S P fY _ _ � - ----------------------------- ------------r , _ ---- --------------------------- (DrX/Qtin a e uir d a Eti - -- C4rt.�.rt-------- -- ------------------- - g q on 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 Scin 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 Compensation laws of California." Signed --------- ------- ----- -- ---- Owner - - - ------ ------------- - ------------- BY --- --- ---- ----------- Title ------------- -�� = (If of er than er) -- - - ------------------------------------- EPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ----- --------------------- DATE =''n=�6-•------------------- BUILDING PERMIT ISSUED --------- -- --- -- -------------DATE ------------------------------------------- ------TIONAL COMMENTS _.---__ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- ------------------------------------------ ----------------------------------- ------------------ Final Inspection by: Date -- _ '-7-t�- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M