71-386 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .� {Complete in Triplicate) -------------------------------------------- Date Issued 4_z-7--71_-.. -_--_---- 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 des c{ibed. This application is made in compliance with County Ordinan a No. 549 and existi g Rules and Regulations: 4 c JOB ADDRESS/LOCATION _ --- ------ -- --------------------=-------------- CENSUS TRACT - �, - Owner's Name --!'�' } � --------- -------------------------------- -----------Phone �p Address ------ - -- ---- - - -Vis.-`-"----�- ----- -------------•---. City -- t I y &9*% t�License # ' - r- -- Phone - -' - -1Y).-90 Contractor's Name ---- ---- - --- -- Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court l❑ Motel ❑ Other -------------- -------------------------- Number of living units:----/------ Number of bedrooms __3------Garbage Grinder )VV------ Lot Size --------- Water Supply: Public System and name .-------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 0 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 TANKSize---4/-- --_ __0__ -_- ------- ---.----._ Liquid Depth Ca acitY --- - - TYPe pu, ------ Material 4��40%& No. Compartments ---3. ............. Distance to nearest: Well -------4- -----__-------------Foundation / -------------- Prop. Line LEACHING LINE [ ] No. of Lines ------3-------------- Length of each line----------—!F!V---------- Total Length ---cavo------------ 'D' Box _- Type Filter Material _-RACir---Depth Filter Material ------- -----_________ ______________ Distance to nearest: Well ---- ------------ Foundation _-/e---- -------- Property Line ---��---��------•--•-- SEEPAGE PIT [ ] Depth ----------- -------- Diameter ---------------. Number ----------------- ---------- Rock Filled Yes ❑ No 0 WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ---------------------------------------- Foundation -------------------- Prop. Line .._----__--_---_.._ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------•---------------) SepticTank (Specify Requirements) ---------------------------- --------------------------------------------------------------------------------1----------------------------- DisposalField {Specify Requirements) --------------------------------------------------- --------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------v-------------------- t raw existing and eq]vired addition_o- n reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin .Y 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: "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 Workman's Compensati n laws of California." Signed ---------------------------- Owner BY ---- ------------------------------------------------ ------------------- ------------------------ Title -------------------- ----------- --------------------- ---------------- (If other than owner) POR DEPARTMENT USE ONLY APPLICATION ACCEPTED --------------------------------------------------------------- DATE __ _ 7 ------------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------------------ ---DATE ------------------------------------------- ADDITIONALCOMMENTS ---------------------------------------------------------------------------.--------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- --------- -------------------------------------------------------------------------------------------------------------------- -------- ----------------------------- --- Final Inspection bY� --�- '------- -��------- -----------------------------�------------------ --------- ------Date _.. -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M