68-755 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 Permit No. a... (Complete in Triplicate) ---------------- ------------------------- - Date Issued ------------ This --------^ This Permit Expires I Year From Date Issued 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 _ 41.1 -------/ 1 ----W_ - ----------- -------------------CENSUS TRACT ---------- -------•--•---- Owner's Name .---�----------- i9 fL - Phone fJ. Address ------ ,------------ e --- --------�------.-��'- ---------------------------------- City ..�7`-'QG° -�C-�-�-Cl�.!-_- - ------------------------- •------ Contractor's Name _.-� ��------------- -- ._ / ` ----------------- - - # /Z741Ff3_ Phone ------------------------------ installation ----------------- ------Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑ Other --------------------- ------------------- I ' Number of living units:---/------ Number of bedrooms 2---_-Garbage Grinder ..1YQ__ Lot Size �_--_X.. I Water Supply: Public System and name =--------------------------------- ------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand[] Silt❑ Gay ❑ Peat❑ Sandy Loam -❑ Clay Loam 'D k Hardpan ❑ Adobe)e 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 tank or seepage pit permitted if public sewer is available within 204 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Q------------------- Liquid Depth _�/4 :----_--------- Capacity _k0__Q--------- Type �^F ° 7'Material-_00WOet-TeNo. Compartments -. ........ Distance to nearest: Well ---------—----------------------Foundation _/Q._---------- Prop. Line _.-.--_._____ LEACHING LINE No. of Lines -----1---------------- Length of each line.-- ._.��...__-- ------ Total Length ._-_ _______...-.-.-- i � 'D' Box -- �6. Type f=ilter Material -�QtrC----Depth Filter Material _--/�-1.__-.....4-_-_-.-.-. . Distance to nearest: Well ---- --------- ------ Foundation ----/,4.-r-------------- Property Line .. .............. SEEPAGE PIT Depth ---;2_5---- _-. Diameter .3_3_.-.-- Number ----.-/------------------- Rock Filled Yes No C1 Water Table Depth ------- -------------------------------Rock Size .? -y-----•---- s Distance to nearest. Well ------"Y`--------------------------Foundation --------- Prop. Line ....ti,5--.----------- REPAIR/ADDITION(Prev. Sanitation+Permit# -------------------------------------------- Date ----------------_--_--------------) ) SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------:-.--------------•---------------------------- Dis osal Field (Specify Re uirements) ------ - ----------------------------------------------------------------------------------------------------------- -------------------------------- --------- -------------------------------- - ----------------- ------------------------------------------------ ------------------------------------------- --------------------------------------------------------------------- ------------------------- I (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 t 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 "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 bette subject to W r an's ompensati.on laws of California." Signed ---------------- - ------------------------------- Owner By ----------------- --------- -----------------------i---- --- ----------- ---------------------------- Title ------- --------- ------ - ---- ---------------------- ------------ - (If other than owner) R DEPARTMENT USE ONLY �a 7_7 APPLICATION ACCEPTED BY ___ @,,__ -------------------------- DATE Gs.�_J. - ---- --------------- BUILDING PERMIT ISSUED ---- 11---- --- --------------------------------DATE -------------•----------------------------- ADDITIONAL COMMENTS ... _ F Q�� ' t - ----------------------------------------------------------------------------------------------------------------------------- --------------------------------- --- ---------------- --------------------------------------- ----------------------------------- ----- --------- --- -- Final Inspection by: . -� Date SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M