70-820 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No.. Q_-r This Permit Expires 1 Year From Date Issued Date Issued lcJ-3d_ 70 t Application is hereby made to the San,Joaquin Local Health District for a permit to construct and install the work herein described. This application N made in•complian IthCount Ordinance No. 549 and existing Rules and Regulations:�. 7 ` JOB ADDRESS/LOCATION.----- `_ �- -,_ _ c9 --------- --- CENSUS TRACT Owner's Name ---- ------------ ----- _'_ 4 Address t ------ City i Contractor's Name "r - License # :-._� Phoned�� Installation will serve: 4 Resident. artment House Commercial ❑Trailer Court '❑ Motel ❑ Other --}--------- --------------I--------------- Number of living units:- _.-.-- Number of bedroom�__ --- Garbage Grind__ Lot Si Water Supply: Public Syste and name ------------------------------- ------------------- --------- ---- -- 4 f Private Character of soil to a depth of 3 feet: Sand' ' a p Q ( Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ 'Clay Loam ❑ '.c Hardpan ❑. Adobeill Material fv-a If yes,type _-.-.___.----_ - (Plot plan, showing size of lot alocation of sysfem in+ relation to wells, buildings, etc. must betplaced on reverse side.) NEW INSTALLATION: fNo septic tank or seepage pit permitted if public sewer is available with-ImL200 feet) (� PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size---------------- - -- -- ---------- Liquid Depth ------------------- 1 - - - -------------- ------- Capacity€._.�_----------•-- Type -------------------- Material --------- No. Compartments-- p --------------_ !� Distance to,nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ------------------ LEACHING LINE [ ] No. of Lines`- ---°`---------------- Length of each line---------------------------- Total Length --------- ------------------ 'D' -------- ------------- "'D' Box ._-_.{____- Type Filter Material""------------------Depth Filter Material .-------------------------------- `�� Distance toinearest: Well ------------------------ Foundation ------------------------ Property Line -----------_-___-_. -_s SEEPAGE PIT [ ] Depth J- Diameter ,--------p- ------- Number ------------------------- -- Rock Filled Yes ❑ No I❑ ` Water Table Depth :__ Rock Size Distance to nearest: Well ------------L-----------------------•_Foundation --.----------------- Prop. Line ---------------.-- REPAIR/ADDITION(Prev. Sanitation Permit# -" =: Dat` ______ _ - = ----------- Septic Tank (Specify Requirements) - " -------- - ' -------------- ---- / 1 Dis osal Field-' S eci�_y ' I P )( pquirements) ) 3 .. i - .;. ,. ------------------------- (Draw a ting 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,_an'd.;Rules and Regulations of the San Joaquin Local Health District. Nome owner or licen- sed agents signature certifies the following: 1 "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 f ---- ------------------------ - ---- By --- ' Title --- � ------------------- � ---------------- -------- (I e t an owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED By".- _---. . 1 --------------------------------------------- ------------------------------------ DATE --- ------------------- BUILDING PERMIT ISSUED =1-___ -_--'O --------------------------------------------------- ----DATE --- ----- --------- ADDITIONAL COMMENTS - ----- ` -------------------------------------- ----------- ----------------------------------------------------=--------------------------- ----------- - -- - -------------------------------------------------------------------------------------------------- ---- ----- Final Inspection by: . - -- - _E A- D -- ,Date SAN ---- �-`--t�'�� JOAQUIN LOCAL HISTRICT E. H. 9 1-'68 Rev. 5M