68-979 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _ - ------------ -------- i (Complete in Triplicate) I --------------------------------------------- Date Issued This Permit 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: r - JOB ADDRESS/LOCATION -.,., - �-`-"-•�---------------------/41/��_�"��'- --- ---"Orel -CENSUS TRACT -------------------------- ----- Owner's Name - ,�� f td/ 1�`, / � 6 ----------Phone ----------------- ------------------ Address --------------------- �------ '�'-�----�1-`-r--(`z�------------------------------ City ------------;-------------------- •-------------• Contractor's Name --/e °" f'�` �^ License #�� .%L �'�- Phone Installation will serve: Residence ❑Apartment House❑ Commercial Trailer Court ;Q Motel,b Other _-- ---------------- 13f �° �'�5� !O O C Number of living units:____ Number of bedroom��'-._.-_Garbagi order , f- Lo# Size ___. __ ---- Water Supply: Public System and name ----------------------------------------------- --------------------- ---------- I----`'---------------------------------------------------------.Private Character of soil to a depth of 3 feet: Sand,0t. Silt 0 E� Clay [IPeat ElSandy Loam ,❑ Clay Loam ❑ Hardpan ❑ Aclobe�e Fill Material ----------- if yes,type ---------------------------- (Plot plan, showing size of.,lot, location of system in relation-to wells, building's, etc, must be placed on reverse side.) F .•. 'I! .. IIII NEW INSTALLATION: (No septic tank or seepage pit permitted'if3pvblic sewer is avnilab[e within 200 feefi,) PACKAGE TREATMENT { ] SEPTIC TANK [ ]1. Size---- ------------------------------- Liquid Depth -------------•------------ _ Type -------------------- Material------- -------------- No. Compartments ------------------- I Capaci#Y --- ---�- -----•- Yp Distance to nearest: Well ------------------------------------Foundation ---------------------- prop. Line --------.....--------- ` LEACHING LINE ( ] No. of Lines ----------------------- Length of each line---:------------------------ Total Length :-----.---..---------------- ° F 'D' Box ------------ Type Filter Material ____________________Depth Filter Material ----- -------------- I Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line. --------- ............ Y�. 2SEEPAGE PIT [ ] Depth --------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No WaterTable Depth ------------------------------------------------Rock Size --------------------------------- Distance --- -------------- ---- ----- -----------•Foundation -------------------- Prop.-. --------------------- REPAIR/ADDITION --------------- - �� Distance to nearest: Well ________________�__________ - - REPAIR/ADDITION(Prev. Sanitation Permit# -•------------------------------------------ Date,:--------------------------------1 { � W ,c Septic Tank (Specify Requirements) --- ---- -------- ----------------------- .SSC 57- ------------ ---- r- Disposal Field (Specify Requirements) ----- �___ - - ` -- r � '----------- - . •- ------------------------------------------------- i (Draw existing and requited addition on reverse side) t 1 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 foilowi ing t � 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 I as to become subject to Workman's Compensation laws of California." Signed - - ----- - e Owner " = Title -a gy - r - --��-�r- i (I er than owner i { '� FOR DEPARTMENT USE ONLY ` _ §e APPLICATION ACCEPTED BY ------ _ _ ._�__ ! V �------------------------------------------------------ BATE _�1- _r!'� ---- ----------- -------- ` BUILDING PERMIT ISSUED ------------ - --- --- :, �. DATE ADDITIONALCOMMENTS ------------------------------- _ ----------------------------------------------------- ------------- ---------------------------------------------� € ---------------------f ----------------------------- - - - -- -- t' ` ------------------- ------ ------ -r - --- ------ Final Inspection b ------Date -_ -'> SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev 5M ��