70-87 - Laserfiche WebLink

Home Browse Search

/ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - (Complete in Triplicate) Permit No. ----------------------------------------- This Permit Expires i Year From Date Issued Date Issued v_- —T o Application is hereby made-to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application pis made in compliance with County Ordinance No. 549 and existing Rules' and Regulations: � C , JOB ADDRESS/LOCATION . -� _ � � --- -�-- =------- -------- --F�-��-� ---- r----------------------- ----CENSUS TRACT Owner's Name _ _. � ---�---- ••---•--- �t ti ------907 4'�O----------------- Address / ,�i J Phone _7120--------- �� -- ------------ City Contractor's Name ______ ,__�__,--_�� -�----------------------------------- � License #J_ri.- : - ---r- Phone �r = ------ ��I/ Installation will serve: Residence Apartment House-[] Commercial ElTrailer Court i0 / Motel [I Other----- --- --------------------------------- Number of living units: ( ^ ______ Number of bedrooms ---Garbage Grinder IV©.--- Lot Size _ �E�:-------------- Water Supply: Public System and name ------ ----------------- ------------- ------------ - Private Character of soil to a depth of 3 feet: Sand'[] Silt❑ Cla Hardpan (] Adobe Fil[❑Material _ _ rdsaifd Y QsoamQ(] Clay Loam M] (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 per fitted if public sewer is available within 200 feet,) 1 PACKAGE TREATMENT f ] SEPTIC TANK, I ize----------------------------------- --- - ----- Liquid Depth -------------------------- \! Capacity --------------------- Type ----------- -------- Material---------------------- No. Compartments --------- -- Distance to nearest: Well ----------- ----------- -----------Foundation ----_----_------__---- Prop. Line ---------------------- . _------__--------_ - LEACHlNG LINE -- �~ [ l No. of Lines ------------------------ Leng of each line---------------------------- Total Length ----------__ D' Box ------------ Type Filter Mater I ---------------_---Depth Filter Material Distance to nearest: Well _____________ __________ Foundation - Property. Line SEEPAGE PIT -`----•-----------••-- �� j 1 Depth ------- - ---------- Diameter --- ----------- Number ---------- ---------------- Rock Filled Yes (] No 0 Water Table Depth -------------- ----- ------Rock Size ------------------____-- - Distance to nearest: Well __._________ ___.__Foundation ----------------- -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit # ______ - --- --------------------- Date ) Septic Tank (Specify Requirements) _______________ Disposal Field (Specify Requirements) �7-_L'- -__-- / Q Q© f --------------------- --------------------- -- ' C'_ -- d�-------------- 1f1� ---------` `P �%C-------� �S' �---------------- -- r (Draw existing and required addition on reverse side) iR 1 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 San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 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 Work n's Compensation laws of California." Signed- t --------------------- -- Owner BY - ---- --------- (if - � � -- ------------ -p ----------------- Title ----------------------------- ------------------------------------------ Yanowner)�"an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___77—t_R. BUILDING PERMIT ISSUED - -------- ----. DATE ADDITIONAL COMMENTS _ �� DATE -------------•--------------- - ---R ----- ` AB- m ---------------------------------------------------- ----- ' .-__ _- __._ �i_ S - _______________________________ __ - w _ -__ -________Final Inspects -- - -- - - --- --------------- ------- -------- ------Date ---- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M