71-432 - Laserfiche WebLink

Home Browse Search

r FOR OFFICE USE: r - APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ._,7/-- - --------- ------------------ i This Permit Expires 1 Year From Date Issued Date Issued �-_/Q___ZL. 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 10?"3Gn_--� _ i-- ----� � s Name - - CENSUS TRACT -- Owner' -------'-----�-Cl-t. ._ --- ----- - -------- -- -- -- - --- ------------------------ ----- Phone --- ----------------------- Address . --•--. City • ::., --------- Contractor's Name _.__ _.__ ._ _ __-_----.License # C `/(�;3- Y �� . _ Phone Installation will serve: Residence'(Apartment House�C],C;q merciol :❑Trailer Court i❑ { a 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 depth4of 3 feet: Sand' Q Silt❑ Clay ❑ Peat ❑ $ Sandy Loam,X 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:.0 fNo septic tank or seepage pit permitted if public sewer is available within 200 feet,[ PACKAGE TREATMENT [ Ill SEPTIC TANK [ l Size_________ ______ _ _____ ____ `4 ------ Liquid Depth --------------------.----- Capacity Type Material---------------------- No. Compartments ---------------------- Distance to nearest: Well _______________ Foundation -!Prop. Line -------------- LEACHING LINE [ ]€ No. of Lines ------------------------ Length of each line.__________________________ Total Length _____--._- ' 'D''Box ------------ Type Filter Material --------------------Depth Filter Material ---- ----------- ---•------ � } Distance to nearest: Wel! ------------------------ Foundation Property Line, ---------------------- - SEEPAGE PIT [ ] DeI fih ------------•----------- P -------- - --- Diameter ---------------- Number -_.----------------R'------ Rock Filled Yes ❑ No i❑ -~-�- i i i Water Table Depth t Rock Size -------=E---------------••- Distance to Inearest: Well ------------- ---------------------------Foundation -------------------- Prop. Line _-------------------- REPAIR/ADDITION .-------------. - -REPAIR/ADDITION(Prey. Sanitation Permit# __________________-¢____°_ ` ` Date --------------------- ------------- ---------------- Septic Tank (Specify Requirements) ________________ I s - Dispos 'I Fielda(SpecifytRequirements),_ ,�- •-•-_--_-- --- L __ _ J F _ ______________._____.____--..__________________________ _---------------------------------------------. _.___i _ ______________________.________-________________ _-___________-_______ __ _ (Draw existing and required addition on reverse side) f I hereby,certify that I have preppred 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. Nome 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 b me bjgctAto Wor " an's Compe�tion laws of California.' €€ Signed ------------ ' ---- Owner BY ------------ -- ----- --------- = --------------- Title --------------------------------- If other than owWl • I I FOR DEPARTMENT USE ONLY APPLICATION,ACCEPTED BY ------ -- DATf _ '�� -------- - ---------------------------------- BUlLDING PERMIT ISSUED ----------------'-----____-- - - -• ----•-------- --------- ADDITIONAL COMMENTS ________�� r�/ � -----------------------------------------------------------------------------DATE -•------------------- -------------------------------------- - ------------------------------------------------------------------------ -- -------------- --------------------- ------------- ------------------------------------------------------------- ------ --- ' - - - -- ---- - -- ---------- Final Inspection by: ----- -- - � _ - �------------ ---------------• ----- --------------------------------------- - Date ------------ Final --v----��,� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M