71-1119 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------- ------------------- I i 1 �' ---------------- {Complete in Triplicate) Permit No. _`7__"_______1– ..........I------------- -------------------------------- -j, -7 / I --------------- -------------------:---------------- This ...............I---------------------------------------------- -------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued __I z_'�_=_-- 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: L77iB".,_ADDRESS/LOCA7a,0 -� — --- - -- h"" _G I aCENSUS TRACT ---`---� -_---•----- Owner's Name ------ -- -- - - ------ --- - - ----------------•------------:--------- - hone ------ Address --- _ -------- City G�^'4 ----- - x � �� Contractor's Name ---- --- -- -- ------License #qAtA Phone Installation will serve: Residence Apartment House�n Commercial :❑Trailer Court ,❑ a Motel ❑ Other ....... ------ ± --____f'.[ Number of living units:------ Number of bedrooms ___<__Garbage Grinder ------------ Lot Size ---------- Water Supply: Public System and name -------------------------------------------------------------- ------------------------------------_.----------Private Character of soil to a depth of 3 feet: Sand'[I ,Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam .E] Hardpan 2( 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 seep ge pit permitted if public sewer is available within 200 feet,) 1# , i cl / z PACKAGE TREATMENT [ ] SEPTIC1 ITANK![ Size- --A_S.___A---15.----_-_---------------- Liquid Depth --------------------..---- h`1 Capacity _1.606- Type _ Material_.------ - No. Compartments ------ -------- Distance to nearest: Well --------got------------____----Foundation ----------- Prop. Line _S___________....._ d0 4 LEACHING LINE [6� No. of Line.s -----__ ------------ Length of each line--_ ��_G_______._____ Total Length �_____________ 'D' Box ----- ------ Type Filter Material ----�__�___--._Depth Filter Material ------C--"�_______________________---___ Distance to nearest: Well _________ 9_!______ Foundation ------�_U_r_________ Property Line __S_ ............ SEEPAGE PIT [� Depth ____ _f_-___ Diameter _It------ Water Number - �______________ Rock Filled Yes � No i❑ ! �• rr Water Table Depth ------------- ---------------------------Rock Size ------ Distance to nearest: Well _____________6_p-+______________Foundation ----CA1-------- Prop. Line ---'r......... ...___ REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ______--_________________-_...____) Septic Tank (Specify Requirements) - --------------------------------------------------------------------------------------------------------- ------ r 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: "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 ------------------------------------ 2__ --- ----- -----------------. Owner TBY ----- :- ---- ----•------- ---- - Title ----- - -- - --------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ __ _. _ _ __ ------------------------------------------------------------------- DATE I_j ____________ BUILDING PERMIT ISSUED -----------------------------------------------------------------• --------------------- ----------------DATE --------------- ------ ADDITIONAL COMMENTS -------------------------------------------------------------------------- ----------------------------------------------- --------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ ------ - ------- Final Inspection by; n2 ----- ------------------------------------- ------ - -- -- ---------- ^flate � 1 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M