68-878 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: j eppLICATION FOR SANITATION PERMIT + U-K-06 1�` �' r� � Permit No: -6L- 7 � {Complete in Triplicate} --- z .� Date Issued ----------------------------------------- --------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliances with County Ordinance No. 549 and existing Rules and Regulations: I JOB ADDRESS/LOCATION . � ,-------------------------- ----- ---- ---------------CENSUS TRACT ------------------------•• Owner's Name -----`; %f77a ----------------------------------------------------------------------------------------Phone ------------------------------------ Address ............ 11-7-�--------------------•------------------------------------------------. City ------- -----------------------------•- I Contractor's Name --- --- 1? _� � ..... -- ---- Licen/se # Phone Installation will serve: Residence �partment House❑ Commercial ❑Trailer Court i❑ 1 Motel ❑Other ----------------------------------------- i Number of living units:--/----- Number of bedrooms _______Garbage Grinder 1�le--_ Lot Size - _ ------______- Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Privatex Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Peat❑ Sandy Loam ❑ Clay-Loam:❑ Hardpan ❑ Adobe ❑ Fill Material ----- ____IIf yes,type __________________________ (Plot pian, 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: Size-_ / -_ -_ __.1__________________ Liquid Depth v - b Capacity IJ_�_----- Type ----- Material MaterialeA4_ wezj o. Compartments _.____ f_____ Distance to nearest: Well __ �_-______________-_-Foundation _.�Q__�_______ Prop. Line ------- Distance to LINE [} No. of Lines .---X--------------- Length of each line ---------- Total Length ./-�� / ____________ 'D' Box Type Filter Material _� ___epth Filter Material ; �/ Distance to nearest: Well _________ Foundation -------- Property Line ---e�� _______:____ i SEEPAGE PIT Depth _- _✓��___ Diameter _,. --- Number ___ - ----------------- Rock Filled Yes No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well -------------------------------- "------Foundation --.----------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ----- -----------------------------------------------------------------------------:----------------...--------------------------- Disposal Field {Specify Requirements) ----------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------:-------------------------------------------------------- (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: 4 "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 to Workman's Com ensati.on laws of California." Signed ------- -------------------- Owner BY ------ 6_- - ---------------------------------------- Title ------ � ----------------------------------- 4 of er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---10- -�'�� ------- DATE --�-- BUILDING PERMIT ISSUED ---------------------------------- ----- -------------------------------------------------=------------ DATE ------------------------------------------- ADDITIONAL COMMENTS __ --------------------------------------------------------------------------- -- - - ------------------- ---------------- ---------- ---- FinalInspection b ----- ---------------------------------------------------------------------------- z 4_ 1 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M j�