71-601 - Laserfiche WebLink

Home Browse Search

t ' FOR OFFICE USE: APPLICATIOWFOR 9SANITATION PERMIT ------------ ----- (Complete in Triplicate) Permit No. --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued _.._ ___--___-______ a 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 _ 7_ .-- / ---- ---( '`--reY!4/ ENSUS TRACT -------------- ----------- Owner's Name ..../- t/` --- h. - Phone Address � �..� ---- ---------------------------. City `_ Contractor's Name _.__ � -------------__-_---- -----------License # F�i.7_ net Installation will serve: Residence El Apartment House-E] Commercial ❑Trailers Motel ❑Other ------------------------------------------ Number of living units:.__- ------ Number of bedrooms ________Garbage Grinder 410---- Lot Size �`.�-_� _ -_ `-_-_________- Water Supply: Public System and name ---------------------------------•----------- ---------------------------------------------9.' --------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loom;K 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 SEPTIC TANK �:tiv tel` _ - "Liquid Depth -------------- ti .. Capacity/ �.- Typedaterial_ , !_ No. Compartments _ ._____...... I I .. /� " Distance nearest: Well _ __________________Foundation / -________ Prop. Line ,1� .___.__ LEACHING LINE _ No. of Lines ` ) ---__-_ Length of each line. -_ --Total Length 4)............. Box� �'._ Type Filter Mater`�� Depth Filter Material ---------------------------- C Distance to nearest: Well _ j�2----__-__.__ Foundation Z47------------- Property Line _._..,w-•--___ SEEPAGE PIT [ Di th ----------- Diameter �0-�i_ Number __________ Rock Filled Yes g No .❑ / . . 'e % } Water Table depth --- -_2------------`-----------.......Rock.Size,, - -- ------------- 4o, � I Foundation p. Distance to near"est: Well - ,��________ aft Pro Line ____._________________ REPAIR/ADDITION(Prev, Sanitation Permit# -------.---------------------------, __ Date _____-..___.______________-_-_____) � s Septic Tank (Specify Requirements) - Disposal Field (Specify[Requirements) �----------------- 0 --- ----------------------------------------------- --------------- - - - ---------------------------------------- F -------------------------------------------------------------------------_------- - --------------------------------- ----------- -------- -------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 11 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: k "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner asi to become subject to Workman's Compensation laws of California." P Signed ------------------------ -- -------------- --- ---- -- - -- -- Owner By - -- ------ -------------- - -----. Title --- t v�_. ---------. (If oth an owner) "9 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-- _ ----------------------------. DATE _6--` 3 `7 ---------------- --------------------------------- BUILDING PERMIT ISSUED --------------------------------'-------------------- ----- - --DATE -------------------- ADDITIONALCOMMENTS --------------------------------------------------------------------------- -------------------------------------------------------------------- ------------ ---------------------------------------------------------- ----------------------------------------------------------------------------------- ---------------- --- -------- - -- ---------- -------- -- -- ---- ----- Final Inspection by: --------------------------------------------------------------------- Date --------------- - -- rr , • SAN JOAQU�IyN� LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M