68-508 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .-------------"----- a [Complete in Triplicate) ----------------------------- Date Issued ------- ------ --- -------------- __—L _ This Permit Expires 1 Year From Date Issued - Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made . compliance with County Ordinance No. 549 and existing Rules and Regulations: - JOB ADDRESS/LOCATION �" CENSUS TRACT -------------------------- - - ------ ---P one ------------ -------------- ------- -- Owner's Name . �-/�f --- / � �-----•-- ----- --------�------------ -•--�- -- -- �+� !� ----------. city _ 'f --------------------- ------- Address -�J._�� ,-, �J �-�` / � _ Phone Contractor's Name -- ��' e9 � f License #/ ,� Installation will serve: Residence 10 Apartment House'[] Commercial ❑Trailer Court .Q Motel ❑Other ----------------- ------------- ---------- Garba a Grinder �a- Lot Size /A� .�Z-`---e7----`--` Number of living units:--"-� -- Number of bedrooms ------ g "-_ private ---- ---- ----------------------- Water Supply: Public System and name --------------------------- - - --------- ------------------peat F1 Sandy Loam ❑ Clay Loam Q Character of soil to a depth of 3 feet: Sand'❑ Silt fl Clay ❑ Hardpan ❑ Adobe 5e Fill Material ---.-------- if yes,type - --------------------------- buildings, etc. must be placed on reverse side.) 4 (Plot plan, showing size of lot,.location of system in relation to if public sewer is available within 240 feet,} N NEW INSTALLATION: (No septic tank or seepage p' permitted _-__ Liquid Depth -------------------------- Capacity .""-".---"---- -------- d PACKAGE TREATMENT { ] SEPTIC TANK',[ ] Size------------------- --------------------- q No. Compartments ------ -------------- i -- Type ------- ------------ Material------------------- P Y - e (, �� Distance to nearest: Well ------------------------------------Foundation --- ------------------- ------"--.Foundation ----------------- --- Prop. Line ---------------------- LEACHING LINE I ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ------•-----------•--------- -Depth Filter Material --------------------------------------•----- 'D' Box ------"----- 7YPe Filter Material ------------------- ------- Foundation ------------------------ Property Line. -------- Distance to nearest: Well ----""---- ----- ---------------- De th Diameter Number Rock Filled Yes Q No i❑ SEEPAGE PIT [ ] P --_---------"- �— 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) -- ---- -------- - - - - (Draw existing _and required uired addition on reverse side) 1 hereby certifyat I have prepared this application and that thee owner or licen- work wil be done in accordance with San Joaquin I Th County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hom sed agents signature certifies the following: 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 - --------- Title ------ --------------------- °[I oth r than owne FOR DEPARTMENT.USE ONLY DATE -".!�__' ;" -- ------ APPLICATION ACCEPTED BY _-�"'P�-------�- - -----------------•--• BUILDING PERMIT ISSUED ------------------ ------- ------------- It----------- ----------------------------------------------- DATE ADDITIONAL COMMENTS ------------------- - ------------------------------------------------ ------------------------------ r --------------------------------- Date Final Ins -_.. --- - --------------- ---------------- --------- - -Inspection b -{' -�' p Y� - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M