70-498 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' / APPLICATION FOR SANITATION PERMIT - - h- --------------- // ----- ---- Permit No. YoL 1f [Complete in Triplicate) f ---------- ----- } i Date Issued _ _ ------------------------------------------------ This Permit Expires T Year From Date Issued E 5'1;5' S._. r4t(G "44_ l-7g -- 01?0—ocl Application is hereby madeyto the San Joaquin Local Health D+strict for a permit to construct and install the w6rk herein described, This application is made in compliance with County'brdinance No. 549 and existing Rules and Regulations- JOB ADDRESS/LOCATION :- }� r�_��__ - -- 9r 'G€NSUS TRACT ------------------ Owner's Name '�� Phone 'y - � `- Address --- --------------�5 'CtSS�1-------- - City "�J C / % Contractor'Name �� -_._��` ---_------- _------------_---License # 3 Phone _-4156 �1__- ; Installation will serve: Residence [2(Apartment House,❑ Commercial MTrailer Court ;❑ I Motel ❑Other ------------------------- ----------- - Number of living units:--.. ---- Number of bedrooms -12------ Grinder, _1V0__ Lot Size ___-_ ------ Water Supply: Pubic System and name - - -------------------------- --------------------Private4. Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ k Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobes] 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 - -- -,-- Ype __ ___.-_ afierial_�•--__ ------ No. Compartments ----�------------- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------- LEACHING LINE [ ] No, of Lines ;_______________________ Length of each line--------------------- ------ Total Length ------ --------------------- I 'D' Box .------ --- Type Filter.Material --------------------Depth Filter Material _<-----------.__--.........._...- .-------- k Distance to nearest: Well -------------- ----- Foundation ___._____--_.______._ Property Line. ________________________ - I � - SEEPAGE PIT [ ] Depth ----------_'---------- Diameter_ ________________ Number ------------------------------Rock filled Yes ❑ No Water Table .Depth --------------------------------------- --•----Rock Size ------------------------ Distance to nearest: Wel! ________________________________________Foundation 1------------------ Prop. Line -----------------____. l REPAIR/ADDITION[Prey. Sanitation Permit# ____________________________________________ Date ___-_-__ ,:__..______________) �4 Septic Tank (specify Requirements) ----------------------------------------------------------------------•---------------------------------------.F--------------- ----------- Disposal Field (Specify Requirements) -- -`- - - --^----------; 1 - ,� - /2------------- ------------------ -------------------------------- --------------------------------------------------------------------------------------------------------------------------------------- (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 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 Work n' Compe anon laws of California.;' ' Signed -------=-- ----------------- Owner -E 9 3 By ............. ------------------- -----------------------`-------------------------------------- Title -------- -------- ---------------- ------------------------------------- '' (If other than owner) R DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY -----------A---------- -----------••-------------="t --------` DATE _-. - G-------------- BUILDING PERMIT ISSUED . ---- --------DATE ---------------------------- ADDITIONAL COMMENTS --------------------------- -------- --- ------------------------- - - - ------------------- --------------------------------------------------------------------------------------------------- ---------- - ----------------------------------- I ------ -------------------------------------------------------------------------------------------------------------------------------- l ---------------------------------- ---- - =- --------- ------------------------------- ---------- Final Inspection by: -- ---- _` -----------------.Date - O -7U_ . SAN JOAQUIN LOCAL HEALTH DISTRICT , _ f ti E. H. 9 1-'68 Rev. 5M. r' A