74-151 - Laserfiche WebLink

Home Browse Search

------- ---- FOR- ------------- OFFICE USE: �. APPLICATION FOR SANITATION PERMIT_ - -- - -- -- (Complete in Triplicate)----- --""---- pcaePermit No: This Permit Expires i Year From Date Issues! Hate Issued `- :-7 Application is hereby made_ to the San Joaquin Local Health District for a permit to construct and install .he work herfn described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO _,_ ,Weyl " ----------- ------CENSUS TRACT E Owner's Name r�Y5 SS -------------- ------.Phone Address __� _ C 'S /1�1 d rVrF ---- -------- . City �' / W_ __/* Tom_ a Contractor's Name '�` - 1p --------- License Phone' �q ` / - Installation will serve: Residence Apartment House❑ Commercial:❑Trailer Court M I Motel El Other -------------------------------------------- ____ Number of living units: _ Number of bedrooms<.__ ___-____ I Garbage Grinder ------------- Lot Size Water ------------------------"- --------------- Supply: Public System and name Private Character of sail to a depth of 3 feet: Sand'❑ Silt C] Clay ------------------------ - - ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material -- --------- If yes, type _._-__._______ ___________ (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 Itank or seepage pit permitted if public sewer is available within 200 feet,[ PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size_____-_____________ -----__ ------------------ i uid Depth ------------- ------------ Capacity Type --------- ------ Mater( o. Compartments -----------" Distance to nearest: Well ____________ _ ___--Foundation _ ___.___ Prop. Line ---•-- LEACH]NG LINE [ ] No. of Lines -------___ __ -_______ Length of a line_______________ _ _ Total Length g -----------•-----------•---- 'D' Box ------- Type Filter Material ___ _ __.___Depth ilter Material -- •---------- Distance to nearest: Well ______________ _______ Foundation _ Property Line -------------- -SEEPAGE PIT [ ] Depth ____._(.-._____-_--" Diameter Number Rock Filled Yes ❑ No -�— - ------------- Water Table Depth ------------ ---------------- ---Rock Size Distance to nearest: Well - ___ Foundation __________________ ----------- ---- --- _ Prop. Line -------•------- REPAIR./ADDITION(Prev. Sanitation Permit _________________ __ " ---------- ---------- Date Septic Tank (Specify Requirements) ------- -------------------------------------------------------------------------- r Disposal Field (S ecify equirements) --------------------------- ----- ---- = j__ ":�_ A ----- ------------------------------------------------ ------------ (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 follpwing: "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 Wor an's Compensation laws of California." Signed - Owner BY ------------ - ------------UC/[ -------- -------------------------------. Title -------- t (if other than owner) FO DE ARTMENT USE ONLY APPLICATION ACCEPTED BY -------- 7 BUILDING PERMIT ISSUED ) DATES .- -------------------------------------- --------------.DATE -------------•-- ADDITIONAL COMMENTS ---------------"-__-- - -------------------------- - --------------------- -- ------------------- ----------------------------------- --------------------- -------------------------------- .--------- ------•---- FinalInspection by ------------=-------- ----------------- -------- ----------------------------- -� " --------------Date ----- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT r' E. H. 9 1-'68 Rev. 5M