76-12 - Laserfiche WebLink

Home Browse Search

FbR OFFICE USE. APPLICATION FOR SANITATION PERMIT .................................. Permit No. .2................ (Complete in Triplicate) ....................................................... G'7(iDate Issued ... .: . . . . ...................... ................ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: s................. ......CENSUS TRACT .........:..._......__.... JOB ADDRE55/LOCATION :..c�.(d.. .._.�._,..:._.. .------ -- r i ...Phone .W.I.:.- .., . . .. Owner's Name ..:dr. .. .............. : - Address ...' ©=( [ a' '•••- ----------------------••---.... City ....... Contractor's Name� ....._ �....�.` .......................License #, f.. Phone '�:�_-. t.S'... .. Installation will serve: Residence 0 Apartment House VCommercia! ❑Trailer Court 0 I Motel ❑ Other -----------------------------------•-•-....- Number of living units------------- Number of bedrooms ............Garbage Grinder _........a_ Lot Size ..�- 1: .. �O• ............... 4 Water Supply: Public System and name ......... ..................-•---------------------------r------- ---------_ ......:.........................Private ❑ Character of soil t a depth of 3 feet: Sand❑ - Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam D + Hardpan ❑ Adobe Material ...._... --- If yes,type --------------------------- (Plot plan, showing size of lot, location ofsystem 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 E SEPTIC TANK ] Size.............-.....................------------ Liquid Depth Capacity --- Type .................... Material.....-................ No. Compartments ..... ............ Distance to nearest: Wei! .__/.... .�3.. .. ___ ..........Foundation Prop. Line ...................... s -. LEACHING LINE [ ] No. of Lines .....--�............ Length of each line._??.................. Total Length 'D' Box ...�._.... Type Filter Material ....................Depth Filter Material :........................................... .: .. Distance to nearest: Well ........................ Foundation --•..................... Property Line ...................... f SEEPAGE PIT Depth Diameter ................ Number ........................---- Rock Filled Yes 0 No .. r ......• ---� r 1 Water Table-Depth..-----•- --...... .... ..Rock Size':--=-.:....--•-•------- ------- ` Distance to nearest: Well .......................................Foundation ----............--.. Prop. Line ----------....... ` REPAIR/ADDITION(Prev. Sanitation Permit# --- ---------------------------.............. Date .................................. L 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 i County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or lican- sed agents signature certifies the following: "I certify that in the rmance of he work for whi thi ermit is Issued, I shall not employ any person in such manner as to become su a Workma Compensation s California." Signe. . . Owner 8 -----• .Title ..... ................................................. i (If er n owner) 1. FqR,DEPAgTMENT USE ONLY APPLICATION ACCEPTED BY .......... .- ---- . ------•. ---•• .......!C/........-•-------------- DATE .... . G ........ ........ BUILDINGPERMIT ISSUED .......... ............................... •-----•••-• ..................................................DATE . . ...................................... ADDITIONAL COMMENTS •.............. ....................................... ------• -•-••..... -�........ ......••--------- :......... :............ �........................................ --- •--... --------------------- —____ Final Inspection 6 ,. i ! 11 _ �.... Date _-- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT F_ k_13 24 1.'68 Rev. 5M 7/72 3 M