71-789 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT c� -------------------------------- . - Permit No. _1'_7 ! .. (Complete in Triplicate) ----------------- -_-_---------------------------------- This Permit Expires 1 Year from Date Issued 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: f � JOB ADDRESS/LOCATION / _-- _- _-- -- -- ----- -- ---- ---`-----�'•�i�1 -1-----------.CENSUS TRACT `�--�-�---.______--_-- Owner's Name 1 ` �- / -------------Phone ?-------- Address -- - ------_3_� ------ --- ----- ----- - .---- - ---.-. City Contractor's Name - = Licensed l� Phones--64 l Installation will serve: Residence XApartmen# House❑ Commercial []Trailer Court ;❑ Motel ❑Other ------------------- `=-------------------- Number of living units:------I_---- Number of bedrooms ____;'_Garbage Grinder ------------ 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 Loom '[:] Hardpan Adobe Fill Material __________ If yes,type __________________________ i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) �J NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) tnl PACKAGE TREATMENT [ ] SEPTIC TANK DS Size------ �[_J�------------------------- Liquid Depth --_.�f�.____._____---- it CapCk acity�� __ - .-- Type /��-]�!---- Material_[ _'__- No.� Compartments _-__._.___�_._._.____. d Distance to nearest: Well ------5b--f----------------Foundation 0------------ Prop. Line .._ _____ "'_____ LEACHING LINE No. of Lines �_______ Length of opch line-------- Total Length ---fes------------ .'D"box ----____t---T�pe Filter Materia[ -_ _ ___ __Depth Filter Material _______ _ _ _______________________ Distance ito`hearest: Well _._ CC t �` foundation _._ d_�" ------ Property Line ------------ SEEPAGE SEEPAGE PIT Depth ------ Diameter -------- Number _.__ ....... ___ _ ____ Rock Filled Yes ' No C1 Water Table Depth ___ ________Rock Siz � l,!y_____________ Distance to nearest: Well _______________________________________Foundation /P------------- Prop. Line ........... REPAIR/ADDITION.(Prev. Sanitation Permit# --------- --=--=------------= Date ---t_______________....----------� t SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------- ------------- .•---------------------------- Disposal Field (Specify Requirements) ---------------------------------------------------------------------------------------- ---------------------------- --------------- ----------------------`--------------------- ---------------------------------------------------------------------------------------------- - - ----------------- -- ------------------ _ (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 to Workman's Compensation laws of California." Signed -------------- ------- .-- ------- Owner BY ----- -- '------- Title (If othe t an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED_BY �' - --------------------------------------------------------- DATE eP-lZ --7-------------------- BUILDINGPERMIT ISSUED -------------------- ------------------------------------------------------------------------------------DATE - -- -------•----------------------------- ADDITIONALCOMMENTS -------------------------------------------------------------- •-•-----------------------------------------------------------------=----------•------ =------ --------------------------------------------------------------------------------------------------- = :---'_-----------= ----------------------------------------------------------- -------- ------ ---------------- - -� -- . y. r , Final Inspection by ---------------------------------------------------------------------- --Date :r_Z- -2 -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M