70-576 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ,APPLICATION FOR SANITATION PERMIT 7v Permit No. s-�� , -----------------------•----------------------------- (Complete in Triplicate) ---------=-------- ------------------------ �`--------- P R Date Issued This Permit Expires 1 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: w U] ------- ---CENSUS TRACT ----------- JOB ADDRESS/LOCATION�,S- -( --GUS- - -- rL( ---- /)--------------------.----------- Ow.ner's Name ---- � �/Phl�fT"--------------------- ---- ------- ---- Phone - ------------------------- Address ------ - ; -------. city Name ------------ ------ -- ------------------------.License # ----- ---:-------------- Phone ------------------------.... Installation will serve: Residence ❑ Apartment House-[-] Commercial ❑Trailer Court i❑ i Motel ❑ Other ----------------------------------------•-- h Number of living units:----1____ Number of bedrooms _'�__-__Garbage Grinder ----`"-___ Lot Size r_ ___ _____ _ ___________...___. Water Supply: Public System and name -------------------------------- ------------------------------------------------------------ ---•---------Private ®� f _ 1 Character of soil to a depth of 3 feet: Sand'Q Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ I! Hardpan ❑ Adobe'W--5111 Material ------------ If yes,type _-_________________________ i (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 200 feet,) 6� �y SEPTIC TANK Size _. __-_____ Liquid Depth ------ -u-`_______________ d PACKAGE TREATMENT { ] � - - Capacity JW3------- TYpe a-ca+ - Material_ No. Compartments --- ------=•--- Distance to nearest: Well -------`j_ _ ______________________Foundation ----1-0 Prop. Line _s1--------r------ I LEACHING LINE [ ] No. of Lines -------3-------------- Length of each line--------__T O----------- Total Length ___97Z ----. ------ I Ii 'D' Box V�----- Type Filter Material Depth Filter Material -__-- ---------=------•------•--- Distance fio Weare;#: Well _.___ '____:___-_°'Foundation ______________ Property Line')- ...- SEEPAGE PIT [ ] Depth ------I-------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes C] No I]] Water Tab]k e Depth ------------------------------------------ ------Rock Size -------------------------------- Distance to nearest: Well --------------------------------•----- __Foundation -------------------- Prop. line ..------•------•------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) 'E Septic Tank (Specify Requirements) --------------------------------------------------------- ---------------------- ---------------•----------- _--------------------•-------- Disposal Field (Specify Requirements) ---------------- ------------------------------------------------ ----------------------------------------- - --------------------------------- - --------- -------- - i ---------- -------------- ------------- ---------------------------------------- I ---- -------- -------------- ------ Draw existing and required addition on reverse side) I hereby certify that I have prepcired this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, acid Rules and Regulations of the Sari Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: i "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 Workman'; Compensation laws of California." Wed . c r '��' � ---------- Owner , ----------------------------- By ------ ---- -------------------------=--------- Title`' 4 (If other than owner) FOR DEPARTMENT USE NLY 0-7---ACCEPTED BY ------- ------------------------------'------------- ---- •---- DATE ----- r BUILDING PERMIT ISSUED ---------- --------- DATE ----------------------- --- I. ADDITIONAL COMMENTS ------------------------ -----------------=-------------- - -- ----------------------------------- ------=- -------------------------------- ------------- -------------------------------------------------------=--- --=------------------------------------------------------ � Date Final Inspection b f------------------------------------------ SAN JOAQUIN LOCAL HEALTH DI CT + fj E. H. 9 1-'b8 Rev. 5M.