70-403 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMlT - ' Permit No. - -- - - ------------ -------- --------- -------------- (Complete in Triplicate) ---- ------- ------------- ------------ 70 Qate Issued _. -.5-"---•. This Permit Expires 1 Year From Date Issued --------------------------------------------------------- 411 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: ! JOB ADDRESS/LOCATION `�-�1------ -.��_.�_P,+----� ---------------- CENSUS TRACT -------------- ----------- Owner's Name - � ------- - Phone 1 I C° r City 7 Address ------ -----C- ----- fA` , Phone Contractor's Name .-_/�^` ------------------------------License # 1 - f� �'� Installation will serve: ] Residence $Apartment House❑ Commercial : Trailer Court IF] i� Motel ❑Other ---------------------------------------- -- Number of living units:-.-!_ Number of bedrooms ".5------Garbage Grinder/ Lot Size ' Private Water Supply: Public System and name ---------------------- ----- ---------------------------•--------------------------- ' Character of soil to a depth of 3 feet: Sand'❑ Silt El Clay ❑ Peat [I Sandy Loam Clay Loam Hardpan ❑ Adobe ❑ 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) I NEW INSTALLATION: (No septic tank or seepage pit permitted if'public sewer is available within 200 feetJ PACKAGE TREATMENT { ] SEPTIC TANK{ I Size----------------------------------- ---- --- - ----------- Liquid Depth -------------------------- Capacity ----- Type e -------------------- Material-- - ----- No. Compartments � P Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line --------------- --- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line__--------------- ----------- Total Length 'D' Boxy----------.- Type Filter Material --------------------Depth Filter Material ------------.--------------------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line _-_-"-_-______------_-- Diameter ---------------- Number ----- --------------------- Rock Filled Yes 'El No 0 r SEEPAGE PIT [ ] Depth -------------------- 1 I Vater Table De th ------------------------Rock Size -------------------------------- IDistance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---.------•--------•-- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------. � s Date --------------=------------------- ---------------- -Septic Tank (Specify Requirements) -------- -- ----------)- ---- ----- fr� f lJ """""" --------- Disposal Field (Specify Req'uiremerts) ----- „: --------------------- �. t --------------------------------------------------- --------------------------------------------------------- Draw exi-sting and required addition on reverse side) - I hereby certify that I Have prepared this application and that the work will be done in accorda�nce with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Distric Home owner or licen- sed agents signature certifies the following: "1 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 ,,,,_ y ---. Title ----- -C 1-11.1 2.e�4 -.---------------------- ----- (If o an owner) ] FOR DEPARTMEN7T USE ONLY Li ' ". DATE __.�4-__� ,✓d(� APPLICATION ACCEPTED BY -------------------------------- = E BUILDING PERMIT ISSUED . - DATE ADDITIONALCOMMENTS ------------------------------------ ----- --------------------- ----------------------------------------------------------------------------- -----• ---------------------------------- ------------------------------------ : ------------- -------------------- ------ __________-------------------------------------------_________ _._ _ __ .- --------------""-"-__._-"_-_-_---"-_--_-"___---- .----____-------- _ ----------------- __ --------- Final Inspection b / -- ----- --------Date �°=1�" '. -- PY= --------------.,------------------------------------- SAN JOAQ N CAL LT ISTRICT E. H. 9 1-'68 Rev. 5M�`