71-415 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --- ----- --------- --- (Complete is Triplicate) Permit No. 7/-7�W-57_______. ---------=-- ---------------------------------- This Permit Expires I Year From Date Issued 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 No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -----` - !_ ..------ -- '-�------j----------CEN51J5 TRACT -------------------------- Owner's Name ,("T - ---- Phone Address}: �{� J -- _ J *a �J 1��,�f i�fi �� city a� ` Phone -_�7 ' ��' - fa �.7 Contractor's Name .�_ � -- ��r.�'"'---------------------------•-- -------.License #1� Installation will serve: Residence Apartment House,❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------•------------------------ Number of living units:...`----- Number of bedrooms,: ----•___Garbage Grinder//a-__ Lot Size __ ` ______________ Water Supply: Public System and name -------------------------------------------------------------------••••-••••••••___----------------------•-Private Character of soil to a depth of 3 feet: Sand'❑ Silt[I 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,) �I PACKAGE TREATMENT [ ] SEPTIC TANK�(d Size__ ----9- y__----_-- ____-_ Liquid Depth __________________ Capacity/2-PttO-------- Typ lo_A 7-_ Material_ - f?c '--- No. Compartments __'�,.�.............. Distance to nearest: Wel __ --�,,;� —� -------------Foundation --/� ------------ prop. LineLEACHING LINE LINE No. of Lines ---��_---------------- Length of each -------- Total Length f_es ----------------- 'D' Box _647''__ Type Filter Material/--;- Depth Filter Material -------------_ ________________ Distance to nearest: Well _-0:7-,?. ---------- Foundation A_0__�_________ Property Line I ........... SEEPAGE PIT X Depth ��------ Diameter �9��_ Number ----f---------_----------- Rock Filled Yes No 0 . +r� Water Table Depth ----- (� , - ------------------------------Rock Size/ ---__------------------ ' Distance to nearest: Well _ ........_---------__Foundation _ ------------ Prop. Line 4----------- REPAIR/ADDITION(Prev. Sanitation Permit# ________________________________ Date -----------------------------------l, SepticTank (Specify Requirements) ----------------------------------------- -----------------------•----•------------------------ -------------------------------- Disposal Field (Specify Requirements) ----------------------------------z-------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ -------------------------------------------- --------- ---- --------------------------------------------------------------------------------------------------------=------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I 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 T .elcxrl ------ (If ck than owner} FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY " �7 ------------ ------- - DATE - - BUILDING PERMIT ISSUED -- ---- -------------------------------------------------------------- ----DATE _--------- ---------------------------- --------------------------------- - ADDITIONALCOMMENTS ------------------------------------------------------------------- ---------- ---------------------------------------------------=---------- ---------------- --------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- - - -- ----- ---------------------------------- ------ ----- Final Inspection by: ' Date -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M