68-616 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------ {Complete in Triplicate) - - - ----- -- - ---------------- - Permit No: ----- -- ------------------ - Issued This Permit Expires 1 Year From Date Issd " 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 Count Ordinance No. 549 an existing Rules and Regulations: em JOB ADDRESS/LOCATION .- g s Owner's Name + "`'� ---- CENSUS TRACT Address ----- ---------------------------------------------------------- ---------Phone �l Cit ---- ------ --- - Contractor's Name ---- __-A- � v Y - -- � G�_rA -- - License � hone - - 0 Installation will serve: ResidenceApartment House❑ Commercial C7Trailer Court i❑ i Motel [J Other ---------------------------- Number of living units:__-'-_ Number of bedrooms t -----Garbage Grinder -- Water Supply, Public System and name _________--_- Lot Size Lr - �__Pi:----- P aracter of soll to a depth of 3 feet: Sand')] Silt Clay -Private Y ElPeat❑ Sandy Loam -E] Clay,Loam IN r Hardpan El Adobe.❑ Fill Material ------------ If Yes, t _____ (Pl'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. NEW INSTALLATION- must be I TION: fNo septic tank or seepage pit permitted if public sewer is available within 200 +} reverse side. PACKAGE TREATMENT ( ] SEPTIC TANK � ) Size--- ------------ ------- `1 ------------------ Liquid Depth -------------------------- Capacity - --- ----- ----- Type --------------------- .Material---------------------- No. Compartments -------__-- -- Distance to nearest: Well -• Foundation Prop. Line --- ------------------ LEACHING LINE [ ) No. of Lines ------ --------------------------------------- Length"of each line--------------------- ------ Total Length -- ---•---•------------•---- D' Box ---------- Type Filter Material - g __Depth Filter Material -------------------- Distance'to nearest: Weil _-_----- _.. ., SEEPAGE PIT = Foundation ______ ___ ____------ Property Line Depth _ Diameter -- --------------••----- -------- - ------ -------------- Number ---------------- --------- Rock Filled Yes [INo Water Table Depth ------------------------------------------------Rock Size --------------- " Distance to nearest: Well ----------------------- - ------- _- _- Foundation ____________________ Pro REPAIR/ADDITION(Prev. Sanitation Permit# _______• -- ---------------------Date Septic Tank (Specify Requirements) --___---_"-- ...... Disposal Field (Specify Requirements) "--- - Ix --_._ -------------------------- e p --- '0 � � 0 , , v 6*--------------------------------------------- ------------ ------------------------ -------- --- -- ---- (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 ----_-- M - ------------ ------------- ----------------------------------------------------- Owner (If other t an owner} ------------------- Title FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --__ - -BUILDING PERMIT ISSUED - -__--- -- ---- -- -------------------------------- - DATE _Y�•� ADDITIONAL COMMENTS -_--_ DATE - - - -- --------------- ------------------------------------------------------- - ---- ------------- - ---------------- ------------------------------------- Final inspection -------- - -- - --------------- ------ ---- ------------------ ---.Date -" --� -' -- - --y =--------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M