70-6 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APpLICATI —PPR SANITATION PERMIT � .� Permit Na. ---_�v=- ---- } ------------- - (Complete in Triplicate) ------- ----------------- ------------------------ 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 made in compliance with County Ordinance Nov. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA&TN .. ......7-id _ --------- one � ---CENSUS TRACT ------------------------- JOB P,DDRESS/LOCAT N __ ___-<---_- -I- --- ---- --------- Owner's Name - - „6 �'. Address -------------------3_7 - --- --- -- -- `-------. City ----------- ------------tl r Lx� � License # �Q�� Phone - 4k-707- Contractor's Name __-_____-- ----- --- --- - -- - Installation will serve: Residence [] Apartment House❑ Commercial❑Trailer Court Motel ❑ Other -------------------------------------------- __ Lot Size,,,f of living units_____________ Number of bedrooms ___________.Garbage Grinder J______ ._ ----- --- ----- - - Water Supply: Public System and name ------- --------------- 'Lri1 ------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt El Clay ❑ Peat[-] Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe �( Fill Material ------------ If yes,type ------------------------ 4 V (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:[ I Size------------------------------------------------ Liquid Depth -------------------------- Capacity -------------------- Type -------------------- Material--------------------- No. Compartments -----------------•---- Distance to nearest: Well ------_-----------------------------Foundation ---------------------- Prop. Line ----- ---------------- LEACHING LINE [ j No. of Lines ------------------------ Length of each line---------------------------- Total Length .--------------------------- 'D' Box _______._- Type Filter Material --------_______----Depth Filter Material __________-_------------------------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ------------------------ SEEPAGE PIT Depth --- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well -------- ------ -------------Foundation -------------------- Prop. Line ----------------..--:- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ----------------------------- - -----------------.. ,_--------------------------- --------------------------------------------- Disposal Field (Specify Requirements) ----------------- ---- i r< �-d --------------- _4--- ------------ ---- --------------- ---------- ------------------------------------------------------------- __- Wsi ----------------------------- (Draw existing nd required addition on revers I hereby certify that 1 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 -------------- ---------------------------- ------------------------------------ Title -- By --------- - - --- --------- ---------- - - �.. (I othe an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- --- ------ - ------------------. DATE ----`--- __-----U ---- -------------------------------------------------------- -- ------------------- BUILDING PERMIT ISSUED ----- ----- ------- -------- - ------------- -------------DATE - ADDITIONAL COMMENTS -- ------------------ ---------------------------------------- rd ---------------------------------------------------------------------------------------------------------------------------------- , o-Z-�� -- —� ----- - - ------ ----- - -------------------- ----------------------------- --------- Date Final Ins ecfiion by: ---------------- ---t- --------------------------- SAN ° ------ SAN i� -- JOAQUIN ,LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M