68-574 - Laserfiche WebLink

Home Browse Search

FOR OFFICE U E: �� APPLICATION FOR SANITATION PERMIT = `r % •�✓ Permit No- ---------------•----- 1 3 (Complete in Triplicate) "a I-+-------- - - -- Date issued -4--,:,7---`-- ------------------------------------------------------ This Permit Expires 1 Year From Date Issued I 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 mad'in compliance with Cou2ixXrclinanae Na. 549 and existing Rules and Regulations: �f F._ �_ `----- ---- - ---------CENSUS TRACT -- JOB ADDRESS/LOCATION ./ -(---j'"� ---- --- Owner's Name _. f '} C �� fi r--------- ---------- - ------------------------------- -- Phone -got----------- I�� ---------------------------•----- Address ------------ Y Contractor's Name ._-. ,,.0e071 �1f' ' ------License # ---------:-------------- Phone - ---------------------------- Installation will serve: Residence 9!1 partment House�M Commercial :❑Trailer Court i❑ Motel E] Other -----------------------------------------er.. s s a / - Lot Size �-.—_--/�- ------------ Number of living units:----1---- Number of bedrooms P-------- Garbage Grind , Private El Water Supply: Public System and name .-___- - �t= ---��---��-�-'��-`---------- -- - Character of soil to a depth of 3 feeLLt:,, Sand ❑ Silt[I Clay ❑ Peat ElSandy Loam ❑ Clay Loam ❑ = Hardpan ❑ Adobe` Fill Material:---_--.---- if yes, type ------------------------ (Plot plan, showing size of lot, location of system in relation`,towells;buildings, etc, must be placed on reverse side.) NEW IN {No septic tank or seepage pit ipermitted..i! public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK'[ ] � -Size- = - ---------- ----- -------- Liquid .Depth -------------------- d # --------- No. Compartments ---------------------- Capacity - ----------------- TYPe :---------- Material -- p ! Distance to nearest: Well ---`-------------------- = i Foundation ---------------------- Prop. Line -------------I a =----• ---- Lens th of each line---------------------------- Total Length ......... LEACHING LINE [ ] No. of Lines -- ------------- ; t --------- ----------------------- 'D' Box .,�---__-- Type Filter Materialti--------------- Depth Filter Material t Property Line -------------------- Distance --- --- Distance to nearest: Well ---------------------::t F undation --------------------- P - - -----•----•---- 3 . ---- Rock Filled Yes No i❑ SEEPAGE PIT [ ] Depth J_------------- Diameter ---------- ;Number --------------------- ❑ ' �.. Water Table Depth -- �yy "' Rock Size ------------------- --.- Pro Line ------- --------_--- Distance to nearest: Well .-__----------------- Foundation P• ----------- i¢tEPAIR/ADDITION(Prey. Sanitation Permit F# -.------------- --- ------- --------- ------------- -# Date ----------------------------------] ; _.. ._ Septic Tank (Specify Requirements) ------------------- - --------- f ------ Disposal Field*........ (Specif R quirements) ------------- -A; ------------ � ' --- 7- t ----------------------------- -- ----------- ----- ------ ------------------ ; (Draw existing and required addition on reverse si e 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: t I "1 certify that in the perforrnance�of the work for which this permit iis¢issued, 1 shall 'not employ any person in such manner' as to become s t Work C pensation laws of California!' 4 Signed -- ---------=-------------- _ Owner , -------------- Title _-.. __. . VI—e------- ---------------------- ---------- (if r than owner) t R . ARTMENT USE ONLY ' APPLICATION ACCEPTED BY ----------- - - DATE ------------- .APPLICATION PERMIT ISSUED ------------- 7__` ----------- -------- --DATE �--- ---- ---------- --------- --------•- A ITIONAL COMM NTS ''� r�" -- ----------- ------------------------------ -------------------- - ------- -- - - -- - ---- ---- - ----- ---- --- --- ---- ------- 1� - - - Date _ ' Fina! Inspection by: .__--__.-- - OAQUIN LOCAL HEALTH DISTRICT A E. H. 9 1-'68 Rev. 5M � .