69-417 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT J� ' F Permit No: (Complete in Triplicate) q ---------- This Per Expires- �r issued -S=am-7 - � p' y Year From Date Issued Date I ---------------------------- 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. 5449 and existing Rules and Regulations: ---CENSUS TRACT -------------- -- ------- I ---------JOB ADDRESS/LOCATION Owner's Name ____ _ Lf'� -- --- Phone ` l"� City - / Address --- �7� t� Phone ___'7_�_-4l= .-- --• ,d --License # 1 r Contractors Name ------------ Installation will serve: Residence KApartment House-E] Commercial ❑Trailer Cour) Motel ❑Other ---------- ------------------------ ' r I X/T------ F G. Number of living units:----- Number of bedrooms ____-__:____Garbage Grinder __ Lot Size ______________ ___ - --., ' - Private Water Supply: Public System and name ------- ----- ❑ Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ : Peace Q Sandy Loam ,0 C14EOarn❑ I s Hardpan ❑ Adobe 4 Fill Moterial -I-___----- If yes,type ------------------- lan showing size of lot,'location of system in relation to wells, build;ngs, etc. mu t be placed on reverse side.) 1%i, {Plot p g l �� `"� NEW INSTALLATION: {No septic flank or seepage pit permitted if public ewer is available.within 200 feet,) U PACKAGE TREATMENT SPTIC TANK[ I Size----------------------------------- 1 Liquid Depth ----- t TypeIMaterial lNo: Compartments ___------=--- ...-- Capacity e ._Foundation ----------- ------.Prop. Line ------------------------ Distance --------- ------ Distancto nearest: Well -------------------- l -- Total Length ----------- ----------•--•-- LEACHING LINE [ ] No. of Lines --------- ----------- Length of each line_.__--___-____.-__-_.__- 9 Type ial --------------------Depth Filter Material ------------------------ ---------------- D' Box�___--___._-- T e Filter Mater. ---_--_- Foundation - 3 Property Line, ---------•------•--=•--- Distanc a to nearest: Well ------------- - ---- t� __-____ Number _ Rock Filled Yes ❑ No i❑ SEEPAGE PIT Depth _ Diameter ----- -- -------- ---- ---------� - Water Table Depth Rock Size --------------------- . Distance to nearest: Well --------------�-------------------------Foundation -----------= Prop. Line -----------_-------- - Ei---------------------- Date -------------------------------- - -1 REPAIR/ADDITION[Prev. Sanitation Permit# --------------�- --- _ ~Septic Tank (Specify Requirements) _._____-.- 8 r� i ------ z Disposal Field (Specify Requirements) ----- , = - - ---------------------- ---------- I4 ----------------------------------------------------------------------- -------------------------- --------------- �- ----- - (Draw existing and required addition on reverse side) I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin f 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: I F� ''��•�a's 1 `. i "I certify that in the performance of the work;far which this permit is issued, I shall not employ any erson. in such manner as to be esu 'ect to W m ' Compens` n laws ofCalifornia." --------- Signed �—, �' - ----------- Ow ner Si ned ------------ Title v , - ------ - ---------------------- -------- CSin (If otherwner) DEWTMENT USE ONLY DATE _ = -----•-- APPLICATION ACCEPTED BY -------- ------ t BUILDING PERMIT ISSUED ----- 4 DATF� - t' AD ITIONAL COMMENTS -----' ---- - !✓�l'! �� !?� 'l_ '' :::: - �� �U Gx� Q -c Q d f-1. �y -f ----------------------------- ----- A --- - - ate .� Date"- --------------- nInsp tion by: - - --------------------------------------------------- SAN JO 4SANJOQUI LOCAL HEALTH DISTRICT_ E. H. 9 1-'68 Rev. 5M.