68-950 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: PPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ---.-._-------------. F --------------- This Permit Expires 1 Year From Date Issued Date Issued IE 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: ?? S JOB ADDRESS/LOCATION .- -sem_ --- �+-- - -- ---------------------CENSUS TRACT -------------------------- Owner's Name i-- ----------------- Phone -- cQ p �- Address --------------------ti-J ------------------------------------------------------- City -=�1 --------------------"--------------------------- Contractor's Na�_y_ -_-------'License # Phone _V110116_i X_1VV1 Installation will serve: esidenceuVApartment House❑ Commercial❑Trailer Court i❑ Motel ❑ Other -------------------------------------------- Number ------------------------------- -- ---Number of living units:----1-__- Number of bedrooms ---'_Garbage Grind r .----------- Lot Size ..-- - _1l. o---_ Water Supply: Public System and name �-f,(' --- `---------------------------------------Private ❑ It Character of soil to a depth of 3 feet: Sand'❑ t❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobex 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 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK [ ] Size------------------------------------------------ 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 -------_----_---_-.--------_--_-_-.... t��` .... . 4 Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line _-----------_---__---- SEEPAGE PIT [ ] Depth -------------------- Diameter -- ------------- Number ------------ ---------_--.-- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size ---------------------------•--- Distance to nearest: Well .__--_____-__-------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------.•--------------) Septic Tank (Specify Requirements) 1-------------- ----------'------------------- -- ------------------.; - Disposal Field (Specify Requirements) -------------------------------------------------------- ----------- ----------------------------------------` - = a ---------------------------i p---11 -4 ----Z-'--3 aC 4;--;Z X---- �5'Id--- (Draw = existing and required addition on reverse sid6l , 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: x ^- "I certify that in the performance of the work for which tipis permit is issued, I shallFnot employ any person in such manner as to becom s ct to Work m n's p ws California.'.'' .I ' Signed -`-.f4 �q, ` "' Owner-" I l JJ D B -�- .Title .� L- ------- ------------- Y ---- ------------------------------------------------- (If other than owner) ,t ENk FOR DEPART T'USE ONLY y APPLICATION ACCEPTED BY -- f-- -------------------------------`--------------------------------------. DATE _.1 _` .-.. ----- +----------- BUILDING PERMIT ISSUED --__--- __-- s DATE ----------------------------------------- ADDITIONAL COMMENTS = --- --------- --. ., - - - ------------------------------------------------------------------------w-- --------------- Finalq inspection by - - --- --------------------- --------------------------------------------------------------- ---.Date ` l _ ------ G SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M