68-1077 - Laserfiche WebLink

Home Browse Search

-;�'PDR OFFICE USE APPLICATION FOR •SANITATION PERMIT��; ;C� � --- -------- (Complete � lCG7� i rr ~' - ---- -- --- --- -----• -� ----- � � Permit No: �- -'- .i (Complete in Triplicate)= r ---------- --------Y____________________________________ Q r ✓ /� Date Issued --------------------- .This Permit Elpires 1 Year From bate 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 de in c nee with unty,(Or 'nonce No. 559 and existing Rules and.Reg Iations: . r - ' �.s . I -:. �' JOB ADDRESS/LO�CA�T]ION . / e � v�//111}1N Q�E'r9�✓d €N5U5 TRACT-------------- j Owner's. Name. flv �!Y 1 � - U1 P ---------- Phone _ 7 - _' --• city �✓- Cc Address f,� ---=--t < --' - ---�__- --- -- --- --------- Contractor's Name -. � z' r_1 - *11 ----- ----------------------------------------License #, rw.l-r_ Phone 5 ,l Installation will serve: Residence N Apartment House f:] Commercial [:]Trailer Court i❑ Motel ❑ Other - ------------------------------------------ units ----------------------------------------- Number of living units:_____---- Number of bedrooms _____Garbage Grinder �0'_____ Lot Size _.m-1�0- Water Supply: Public System and name—--------- ---------------•---- - ----------------•------- -------------------------------•---------Private " —Chdracterof`soil-ta a de th of-3-feet:'" -Sand' Silt 0--Cl-ay` Peat" Sanely Loam-' "Cla Loom Hardpan ❑ Adobe ❑ Fill Material yes, type ______. -- _'______________ (Pl'ot 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 seepag permitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT [ ] SEPTIC TANKSize----- _j(x--5--- Liquid,Depth __:_ly ______.____- Capacity 1_SQ- -,-- Type, Material Material__e10NtP_-,No. Compartments -_-- Distance to nearest: Well ---- _'6------------------------Foundation ------ _ f Prop. Line .___- -------- LEACHING LINE V-"*No. of Lines ___.Z------------- Length of each line--------7S�______ Total Length --.-.-- Al 'D' Box ------ ----- �Type Filter Material � bG�{---Depth Filte Material ----- --___-- _______ Distance to nearest: Well ---------�-_ Foundation -,/47------ Property Line Ur- SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No 0 i Water Table Depth _____________ -----------------------------------Rock Size ------------- ------------------ Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------•-------.------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic ____ .___________-_-------- ---Septic Tank (Specify Requirements) --------� ----------- ------------------•-----------------------------------------------------•---- Disposal Field [Specify Requirements] ________________ __ (Draw existing and required addition on reverse side) I hereby certify that J;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 "1 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 Wo man's Compensat' n`laws of California." Signed ---- -' , ZEPARTMENT AOwner Title -- --------------------------------------- ` (If.other than owner) FORUSE,;ONLY APPLICATION ACCEPTED BY -- DATE -- -- BUILDING PERMIT ISSUED,--=-- -------------= ' s ` ' ----- DATE __1- --- ------------------------------- ADDITIONAL ----- - ADD1710NAL COMMENTS -- - ------- ---- - --------------------------------- - --- --------------- � ' ti • ------ ---------------------------------------- ----------- --------- --------------------------------- ------------------------ -------------------- ------------ -------------- _" __' _ _ -- '---------------- ------------------- ------- Final Inspection 3 =-------=----------------- N. ---------------N. J LOCAL HEALTH DISTRICT E. H. 9 , 1-'6 Rev. 5M 2 � •