72-179 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------- -------------------- (Complete Triplicate) Permit No. I - ---------- -------------------------------- ------------ -----_-_-- This Permit Expires 1 Year From Date Issued Date Issued --�--_Z1-? Application is hereby made to the San Joaquin Local Health District for a per 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 A �T ---------- �� *-c CENSUS TRACT Owner's Name -------- --------!— --�-----�j ------ / �60 Phone ! Address --- --------------�� G -C .------ ----------. City ---- Contractor's Name .--.__ -- ---- , --- .......License # _� L_-��_�_ Phone - _ b`" Installation will serve: Residence KApartment House�❑ Commercial ❑Trailer Court ;❑ / Motel ❑ Other -------------------------------------------- �- Number of living units----!-------- Number of bedrooms _____..Garbage Grinder ------------ Lot Size --4�41-l-7)_c_1_63_______________ Water Supply: Public System and name ________________________________________-_______________-------------- Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay FIPeat❑ Sandy Loom •❑ Clay Loam ❑ Hardpan ❑ Adobe 1K 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted.if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[// Size-----_��____x__�__-__------- ._._____._ Liquid Depth __- _______ --. Capacity /.��_G;94ype ___ Material__CV ? Ce_<_, No. Compartments ___�---_-------- r � Distance to nearest: Well -------------------------------------Foundation ___10----_----_ Prop. Line - . ....... LEACHING LINE [ ] No. of Lines ____ Length of ach line---------------------------- Total Length N nn 'D' Box -____�_I_ Type Filter Material __ #T ..__Depth Filter Material _____l_ ___��_______________________ �K�tf� ! f Distance to nearest: Well ___________________ Foundation ----- Property Line __ _. SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ___________________________ Rock Filled Yes ❑ No Y❑ Water Table Depth ------------------------------------------------Rock Size ----------------------•----•-- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _-.------------------- r REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) t 4 SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------••---------------------------- Disposal Field (Specify Requirements) ------------- ------------------------------------------------------------------------------------- - -- -------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------I---------------------------------------- (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 other th wner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- ---------•----------------------------------------• DATE --- __7 Z-_------------- BUILDING PERMIT ISSUED _,--------------------- - ------DATE --------------------- ADDITIONALCOMMENTS ------------- ------------------------------------------------------------------------ -------------------------------------------=--------------------------- ------------------------- -------------------------------------------------------------------------------- '----------------------------------------------------------------------------- --- ----------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- ---------------------------------------- to--- --------- ------ : Final Inspection by- --------------------------------- a--- ,---0L ------- -----------Date --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M