72-1099 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a .. .. t P%rrnit No: /a9 9 --------=------------ ------------- ----------- ------ (Complete in Triplicate) 1 _ . -- ------- ---------=-- -------------------------------------------- -7y p _��`� This Permit Expires 1 Year From Date Issued Date Issued 44 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 -------- - - - fir- - - - I -- - CENSUS TRACT ------------------ ------ Owner's Name. .. � --------- _ Phone -------- -------------------- Address ---- -----. City ---------- _ -------------------------- --- -- ----- Phone PGj License # � _c --Contractor's Name ------- Installation will serve: Residence gApartment House❑ Commercial []Trailer Court-;:0,.,: Motel ❑ Other ------------------------------------------- i Number of living units:.____ Number of bedrooms ---.~Garbage Grinder -------------- Lot Size _ -�~- Water Supply: Public System and name -------------- ------------------------------------------------------------------------------------------------Private B t Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam 0 — 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.) )13 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ' PACKAGE TREATMENT [ SEPTIC TANK[ ] Size/en ----- ---------------------- ----------------- Liquid Depth --------------------------- Capacity -- --------------,----. G ` Capacity --------------------- Type ------------- aterial- ------ ------------ No. Compartments ---------- ........... t Distance to nearest: Well - ------------ ---------------Fou dation ---------------------- Prop. Line -------------_-.------ LEACHING LINE [ ] No., of Lines _______-------------- gth o each line--- ------ ----------------- Total Length -----------._._._-----.._.-- ', 'D' Box ------------ 'Type Filter rial ------------------- epth Filter Material -----------------------.-------------------- Distance to nearest: Well ___ _____ ____-_ Found ion .___--------_______---- Property Line ____--_______-_---._.--- SEEPAGE PIT [ ] Depth ____---------------- Diamet --_ _____-____ Num er ----------- ---------------- Rock Filled Yes ❑ No ❑ Water Table Depth ------------- ----------------------------Rock Size -------------------------------- Distance to nearest: Well ----- ----------------------------Foundation -------------------- Prop. Line .............<-----_-. REPAIR/ADDITION(Prev. Sanitation Permit# ------------ ---------- ------ Date _-_-________-________-----------_Septic Tank (Specify Requirements) ----------------------- ----------------------------------------------------- ---------------------------•--------------------------•- Disposal Field {Specify Requirements) ---------------------------- -------------------------------------- -- ------------------------ - t' 1, ----��-------,ryes . ., _ ---------------- -= --- _ - -__-_---------------------- (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 r County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- 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." t.r Signed - -- - ---- -------- --------- - ---------------------- ----- -------------------- Owner - Title ---- ---------- ---------------------- --- -----------------------BY P (If other than owner) FOR .DEPARTMENT USE ONLY 1 � APPLICATION ACCEPTED BYs -�--------------- DATE ----IV_-. ,.7----=---- [ i BUILDING PERMIT ISSUED ----------------- --------------------- - -------------------------------------------DATE --------------------------------------- -------------- ADDITIONAL COMMENTS _.._ ------------------------------------------------- ----------------------------- - -- ----------------------t - -------------------- ------------------- ------- -------------------- ----- --a ----------------------------------------------------------------------------------- -------------`---------------- ------- -------- -- ------------------- ,�t� J ------------- -- -- -- --------------------------- --- �lt Final Inspectiitt-I ------ --- -- ------ ' ` Date . 7�,' SAN JOAQUIN LOCAL HEALTH DISTRICT - J E. H. 9 1-'68 Rev. 5M