72-1067 - Laserfiche WebLink

Home Browse Search

#,_..-' '� ,FICE USE: APPLICATION FOJt SANITATION PERMIT(Complete in Triplicate)---------------------------------- Permit No. --7, -�--�7-- ------------------- ------- ----------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued /�_��72- ------------------- 2- Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is �made fin compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA ON --/�---�-T� '----- - - -- --f -- --- --------------CENSUS TRACT ---- -------.-------- Owner's Name --- Phone � f - ------ - ---------- -- Address -------------------- d --- --- ----- City -- Q- . (---- Contractor's Name -- - , --- -- - ----- ---- ---_ - --- License #c� /__ -�L Phone ,. -� � Installation will serve: Residence ( Apartmen House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units------------- Number of bedrooms _ ____-Garbage Grinder --------- Lot Size --_-------------.-_-_---____-______------ Water Supply: Public System and name ----------------------•---------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam R Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type -------- pian, 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,) J/ IN, PACKAGE TREATMENT [ ] SEPTIC TANK'f ] Size_T_ � �- ee Liquid Depth -----J3-_--------_ V Capacity/W---- -- TypePeAlk- Material---& No. Compartments -a2 - Distance to nearest: Well ---- CoQ------------------ � ---- p. �. --_----- d Foundation _ ---_--- --_ Pro Line -- _- LIN(; [ ] No. of Lines ----- ------------ Length of each line- - - Total Length _- J ------------ LEACHING -- D' Box _-_ -____ Type Filter Material /&J— OA epth Filter Material ---___-_!_� --------------------------- 1 `/ Distance to nearest: Well -_-- Q----- ---_- Foundation _� _______________ Property Line J---_----_-_-_._.__- SEEPAGE PIT [ ] Depth - 26 --- --- Diameter - �- --- Number _---_-__-_ ____�__ Rock Filled Yes Eg No i❑ Water Table Depth --------7--.-------------------------------Rock Size ------- - Jthrk- Distance to nearest: Well _1490--------------------------Foundation _.-S-49--------- Pro Line - REPAIR./ADDITION(Prev. Sanitation Permit# ------------------------------------ Date -----------------------.----------) Septic Tank {Specify Requirements) ----------------------- - ------------------------------------------------------------------- .------------------- ---- .. Disposal Field (Specify Requirements) ______________________ -------------------------------------------- - ------------------------------------- ---------------- -- -- - ------------------------------------------------------------------------------------------------------- (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 San 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Z��---- -- - -- ----=------------------------------------ Owner � ------------- ,7itle --------- --------------- ----------------- ---- --- - ----------------- tha owner( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY;�L DATE �� -.1f� BUILDING PERMIT ISSUED . _ DATE -------- -------------------- ---------- ADDITIONAL COMMENTS ---- l .} - - --- ---=-------------- ------------ ----- --------------------------------------------------- ---------------------------------------------------------- -------------------------------------------- -------------------------------- ---- - --- ------ - - - - - - - - - Final Inspection by ------- ---- -- -------- -- - - - -- Date SAN JOAQUIN LOCAL HEALTH QISTRICT E. H. 9 1-'66 Rev. 5M