69-615 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ Sr Permit No. ��--��--------� --------- - ----------------------------------------------- t (Complete in Triplicate) r ' Date Issued _ - S'=�pf This Permit Expires i Year From Date issued e work Application is hereby m o esis° dean complianceal wiHh County ealth trict for a Ordinan e Nom549 and ex sting Rules tand hRegrylationsrein described. This application (Ztl I/vZ CENSUS TRACT - - JOB ADDRESS/LOC ION . -------------- -- a� - --------- Phone Owner's Name ------------------•------------ ------ City • -- ------------ ----------- -------•--•------ Address _- --- -- - ----- - --- --- ------ - 3 Phone--------------------_---•--- - � License #t�� --� -- Contractor's Name ------ ------- -- -�----- ---- �--� --- -- - -- - - installation will serve: Residence partment Hou se❑ Commercial :❑Trailer Court ❑ tt Motel ❑Other --------------------------------------- Number of living units:------)_____ Number of bedrooms :-r�.-"Garbage Grinder ------------ Lot Size _____-___------- -------------• . . ------- -----------------�Private �--- - -------------------- Water Supply: Public System and name ------------- ----------•-------- -------- --------- - Peat❑ Sandy Loam ❑ Clay Loam:❑ Character of soil to a depth of 3 feet: Sand'❑ ilt❑ clay ❑ Hard an Adobe ]] Fill Material --_-___---_ If yes,type --------------- • p (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,) SEPTfC TANK'[ ] Size ------------------------------------- -------- Liquid Depth ---------------------.--ti- PACKAGE TREATMENT [ I 11 Capacity --------------------- Type ------ ------------- Material------------- ----- No. Compartments �l a - - - Prop. Line ----------------- Distance to nearest. Well ___,_______________________^}"` Foundation _____-_____________ _ m r ` ------ Tatal Length LEACHING LINE [ I No. of Lines ------.-------- y Length of each line____-______ _--- _ -- �— -De Depth Filter Material --------------------------------------- - 'D' Box ... -- ---- Type Filter Material -_---------------- p Property Line ----------•-------- Distance to nearest: Well '"---------------------- Foundation ____--_----------------- p �Y ----- ---- - --�- -No, - De th - Diameter Number ------------------------- Rock Filled Yes ❑ SEEPAGE PIT [ ] p Rock Size -------------------------------- Water Table Depth ----------------------------------- --- , Distance to nearest: Well -------------------------=------------- -Foundation -------------------- Prop. Line ------- •----- REPAIR/ADDITION(Prev. Sanitation Permit# ------ Date..---_------------------------------) # _- , Septic Tank (Specify Requirements) -.---.------ ------------------------" f ----+------`---------------- ----------------- ----------------- Disposal Field (Specify Requirements) ---------------- -------------- } G� ------------------------ -. < ' ------------------------ 44 n 4 � [Draw existing and required addition on reverse side} I hereby certify that I have prepared i this apph,'cation and that the work will be done in accordance with San Joaquin i County Ordinances, State Laws, and'Rules aand Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: d "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 - �-� f By ------ ....6 I (If other than owner) f FOR DEPARTMENT USVONLY --------------DATE ------- ------------ 9---------- e APPLICATION ACCEPTED BY --- - --------- ------------------ --- --------- --------- --------- ATE ---�-- -�c��-- - BUILDING PERMIT ISSUED -------------------------------- ---------------- --- ADDITIONAL COMMENTS -------------------------------------------------- - - ------------------------------ ----------------------------------------- ---------------------- --------- ---------------- -------- 17 --- - Date" Final Inspection by SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M ► a as 4