71-1148 - Laserfiche WebLink

Home Browse Search

1 FOR OFFICE USE: 1� APPLICATION FOR SANITATION PERMIT ---------------------------------------- ----- f Permit No. - - I � (Complete in Triplieate) ' ------- ----------------------------------- /4 7 Date Issued This Permit Expires 1 Year From 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 sMade in compliance with County Ordinance No. 549 and existing Rules and Regulations: .ter ,1J = RC1 1 L40-L? --- CENSUS TRACT JOB ADDRESS/LOCAATT7ION ._ 11 � I ---- --f -"f � ��-I�_G _ Owner's Narrie _._C _� !`� �� f � b '-' ' gewg, Phone Address T-of-gol7� Cit 0A --------------------------------- Jh i u---- -=------------- -- ------------------------ Y -- -- ----------- Contractor's Name ---._--. lip `/ -------.License # --------- ------------ Phone ------ ----,------ - -/I Installation will serve: Residence ❑ Apartment House❑ Commercial 5ftrailer Court ;❑ Number of living units:------------ Number ❑ _ _ Other _._ ___-- -------------------------------- I u umber of bedrooms ____________Garbage Grinder ------------ Lot Size ------------------------------ -------------- Water Supply: Public System and.f name ---------------------- - ----------------------------------------------------------------Private 19 i Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Peat[:] Sandy Loam ❑ Clay loam El .� Hardpan ❑ Adobe-❑ Fill Material ------------ If yes, type ________________.________-- x (Plot plan, showing size of loft, 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,) t [ SEPTII PACKAGI TREATMENT C TANK'[ ] Size--------------------------------------- -------- Liquid Depth ------.-_______-------.,-- I� CCa acit ------ Type ----- ------------ Material-------------------- - No. Compartments apacity, --------- ------------------Foundation --------------------- Prop. Line ----------------•----- Distancel�to nearest. Well �___ _ 1 LEACHING LINE [ ] No. of Dines ------------------------ ngth of each line-------.--------- --.----- Total Length ---------------.------------ Depth ,Filt r Material ___________ __-_ 'D' Box !1__--------- Type Filter M terial --------------------- P _ - --------------..,_..------ �„ Distanceiito nearest: Well ------ ----`------------ Foundation ------- --------------- Property Line ----- -- SEEPAGE PIT Depth ii ------- Diamete ________________ Number - --------- ___.----_------- Rock Filled Yes ❑ No lQ r Water Table Depth ------------- __Rock Si -------------------------------- Distance ------------------------------- f Distancel`to nearest: Well ----- ----------------------------------Found ion ------------------- Prop. Line -------_--------__.. REPAIR/ADDITION(Prev. Sanitation Permit# -------- --- ------------------------------- Date ___ ____--__________---------__---) Septic Tank (Specify Requirements) --------- -------------------------- r --------------- ------- --------------- Disposal Field (Specify Requirements) .. _ _ __.----- : - --------------------------------------------------------------------- --- ------------------------ -------- --------------------- j I� --------------------------------- ------------------I--(,Draw---- e --------- ---- aired--- ._ 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,land Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: I "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 Wo main's Compensation laws of California." Signed -- ----- --------------------- --------- Owner --------- TBy itle -------------- ------ ............. --- �� (If other than owner) t FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY --- f-------------------------------------------- ------- __. DATE -71 �I BUILDING PERMIT ISSUED -------- ------------------------------------------ DATE ------------------------------------_------ ADDITIONALCOMMENTS --------- ------------------------------------------------------------------- ----------- =------------------------------------------------------------------------------------------------------- il------------------------------------------------------------------------------------------------------------------- ---- -------------------------------------------------------------------------------------------------------------------------------------I---------------------------------------------- � --------- -----Inspection b ` -----Date P Y SAN JOAQUIN LOCAL HEALTH DIST CT i G [ E. H. 9 1-'68 Rev. 5M