95-1010 - Laserfiche WebLink

Home Browse Search

, FOR OFFICE USE: _w APPLICATION FOR SANITATION PERMIT (Com lete.in Triplicate) Permit P A . -•••••........ ...... This Permit Expires t Year From Onto Issued Date Issued e2..:4. ..: S Application is hereby made to the San Joaquin Local Health District for o 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: r J06 ADDRESS/LOCATION ^ --- ------------- -.. ............................:............:.......CENSUS TRACT ..._...................... Owner's Name •---_.. - ,.. . ..... .......-••- 1.1............ ................Phone . .X-0Address ._.._.._._ .�_� i>-- •._- ...... City ................ ... Contractor's Nome -• -----••---- ------- --- -.M �' -•---..i)._.License # .1. 3 ..... Phone Installation will serve: Resident ❑ApartmentHoousefl Commercial []Trailer Court 0 Motel ❑Other Number of living units:_-- _ ----.- Number of bedrooms ......Garbagefrincleir4�. Lot Size ... Water Supply: Public System and name ............. Private ` Character of soil to a depth of 3 feet: Sand E] Silt 0 Clay [:1Peat❑ Sandy Loam f] Clay Loam 0 Hardpan Adobe ❑ Fill Moteriol •----- --... If yes,type ............... ............. (Plot plan, showing size of lot, location of system in relation to wells, buildings; etc. mustbeplaced on reverse side.)_ NEW INSTALLATION: (No septic tank or seepage pit permitted i�Public sewer is avoilable within-200 feet,) y PACKAGE TREATMENT [ ] SEPTIC TANK 14' Size•41.1. ._-- .� •�-•-�•----�---•._.. ....... Liquid Depth Capacity _I ts_......_ Type -• Material..,.,...- No. Compartments .._.c ........ o .......... Distance. to nearest: Weil _..-------d0.1111-••-----------Foundation .... •-p_. ---- Prop. Line':4^�....... t LEACHING LINE [dr No. of Lines --------I....._.__ f,�-- --. Length of each line.._.... P-.' ....... Total Length .-.-Y.a.. .....m 'D' Box ..... Type Filter Material _$A........Depth Filter Material ......II I � ,� ........................-----. Distance to nearest: Well .......$4 Foundation ......PP._�'._-.-- Property Line ...... SEEPAGE PIT � Depth •� Diameter � __ --- Number ........�.....:............. Rock Filled Yes [8' No Water Table Depth -------------J.B p-- '" --...........Rock Size --.f..`/ _ . .rf p Distance to nearest: Well --------------- --- • ----Foundation .................... Prop. Line ...................... REPAIR ADDITION(Prey. Sanitation Permit# _-1__1--............ ................ Date .............-............ Septic Tank (Specify Requirements) ...:..............• ---••-•-------•................... _ ...................•-........................ •-•---•---..._........•_ Disposal Field. (Specify Requirements) ------------------- -- (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 Mules and Regulations of the San Joaquin local Health.District. Horne 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 ------ ------------ r •--- -•- Owner BY -- T tie �l + .: Ilf other than owner) r -------- ......................... FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ :...:...:....... ---- I� !' BUILDING PERMIT ISSUED --.-.-- DATE - - - .._.. ©ATE - - ----- ADDITIONAL COMMENTS ..-._.-_. �._-•-•_-.- .------- ------------ ---------------•----------•-•------------•--------- -----•---------•--.--.-. ----------- . ----....---.I..._..-..--- ---------•• •• Final Inspection b -----------------------------------------------•---••----.------------- y: ..---�...............-: ..=----• ---•-••---•._.._.---••--•----•-••--------•---.._..---•-- ----.._..__,......-----..Date .. .- --... ._ ...� ' ' 13 2ti 1-613 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M