68-650 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 'W APPLICATION FOR SANITATION PERMIT -------- ------------------------------------ (Complete in Triplicate) Permit No. -------------I This Permit Expires ! Year From Date Issued Date Issued r 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 compliant with Count Ordinance Nq. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI -- -- -- ---------- --- wa_-�,�_CENSUS TRACT ______-____ --._____ - Owner's Na - Pone ---------- - ---- --- -- Address -- ----- --�._--�f---'�� • - - ----------�- ------ r�-- --- City ----- - ------------------------------------ ---- Y c License # -- Contractor's Name _._:__ Installation will serve: Residence [ partment House❑ Commercial: Trailer � �'hone ❑ Court ;❑ ' Mote! ❑ Other Number of living units: ._-_ Number of bedrooms ------Garbage Grinder ------------ Lot Size Water Supply: Public System and name -----------__ _--_ __._ - - -- ------•-------- ------- ---- ------- - Private 'Character of soil to a depth of 3 feet: Sand [] Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type __-_______ _________ (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 f ] SEPTIC TANKq p - v [ 7 Type Size------------------------ ---- ------------------ Liquid Depth -. V Capacity - ---------------- T e --------------- --- Material------ --------------- No. Compartments Distance to nearest: Well ------------------------------------Foundation _-----___ ----------- Prop. Line ----------------,_-.___ "1 LEACHING LINEI f ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ----------_--- -------------- 'D' Box ___1---------- Filter Material ---------------------Depth Filter Material -----:_____-______ 4 Distance to nearest: Well ________________________ Foundation -------- --------------- Property Line _____ _ SEEPAGE PIT [ ) Depth ----.►-------------- Diameter - __ _ I --- , Number -------------------------- Rock Filled Yes . Water Table Depth ------------------------------------------------ - 0 o 0Rock Size Distance toI nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------------._ REPAIR/ADDITION(Prev. Sanitation,Permit# ____.__..._----------------- -------------- Date Septic Tank (Specify Requirements) ---------------------------------------------- Disposal _ __Disposal Field (Specify Require nts) -------- - ---- ------- - ti ---------- ------------------------------- - ---------------------------------------------------- _7 ------------------------------ - ------------------------------ /[ - --- -------- - --------- -------------------------- -d ---- ------�-----,-,�-,- -----��'----- - � r . 1, i - __ __ J(Draw existing and required ad ition o reverse side) 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin E� County Ordinances, State laws, anti 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 an as to become subject to Workm - mpensation laws of California." p Y Y Person in such manner G Signed = -------- Owner -,, .i I ----V ----------------------------- ---B11� y ----- Title . . :. (If other than owner) j --------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- --- - ------------------------------------------- --------------------- DATE ~ BUILDING PERMIT ISSUED -- 1--- ---------------------------------------- DATE ------------------- - ADDITIONAL COMMENTS _-.____-_-___-� _ - ---- f ----------------------- -- 11 _ ----------------------------------------------------------- ----- - -------------------------------- __ ----------------------------------------------------------------- -- --- ---------------------------------------------- --------------------- ------------- --- ----. -------------------------------------------- Final Inspection by: . . - --------- Date;?— SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M