69-436 - Laserfiche WebLink

Home Browse Search

! FOR OFFICE USE: ! -�! APPLICATION FOR SANITATION PERMIT -------------------------------------- Permit No. 3� (Complete in Triplicate) V Date Issued9/�� -�--.•-- ---------------- This Permit Expires 1 Year From Date Issued 1! , 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: JIOB ADDRESS/LOCA N __- _ - CENSUS TRA T -------------------------- ^ � 7 ---------------------------- Owner's I Name ` --------•---Address - City Contractor's Na -----------------------------------License #116_ q ` fa+hone -------------------------- installation will serve: ! Residence " rtment House-E] Commercial ❑Trailer Court ❑ Motel EJ Other ---- - - -------------------- Number of livingunits:---- --_--- Number of roo��_ __ . *' D U _----Garbage Grin r - -- Lot Size ----!._. ---/` -----------•----_ II Water Supply: Public System and name ------(, --------------------------------------------------------Private ❑ II !Ip of 3 feet: Sand'o Sil ❑ CIO Peat E] Sandy Loam ❑ Clay LoamJE] °.. t Character of sol to a depth Hardpan ❑ t Adobe' Fill Material --40-- 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,) V PACKAGE TREATMENT SEPTIC TANK [ ] Size----------- ----------------------------------- Liquid Depth --------------------------- Q Capacity --------------------- Type -------------------- Material--------- ------------ No. Compartments ------------------•--- Distance to nearest: Well ---------------------------------Foundation ----------------------.Prop. Line -----------......... LEACHING LINE [ } No of Lines ----------------- --- Length of each line-- ------------------------- Total Length __._-_-_.-.__...------..__ ii 'D' Box ------ Type Filter..Material --------------------Depth Filter Material -------------------- ----------------------- Distance to nearest: Well _______________________ Foundation -----------------------. Property Line -__---_-_---_-_-------.t II , SEEPAGE PIT [ ] Depth.. -------------- Dineter ---_--_-__------ Number ---------------------------- Rock Filled Yes ❑ No ,i❑ f - : a Water Table Depth ------------------------------------------------Rock Size -------------------- ........... r: Distanceto nearest:.Well ----------------------------------------Foundation -------------------- Prop. Line -.-.-----------_---- REPAIR./ADDITION(Prev. Sanitation.,Perm it# t.-_---.----------------------------------- Date --------------------------- ...... AV* . Septic Tank (Specify Requirements) -- /1 •---••---- I Disposal Field (Specify Requirements)_------ X_-. ---------q�- --L--:- - _ -----------U-------------- -----------•---=-------- d.4-4- ' --------------------------------------------------- �- it } (Draw existing and required addition on reverse side) I thereby certify that I have prepared this application and that the work will be done in accordance with Son 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 -------- --- -- ---- -- --- ----Q-- --- -- -- -.--- ----11 - ---�....�.._. _.-- .- __7=Owner BY ---- ---- 4¢ r -t Title � t2. III `[f ther than owner( 1 FOR DEPARTMENT USE ONLY' APPLICATION ACCEPTED BY -T-C- ---- ------ -------------------------- ------------------ DATE $-f`' ---------- r ` BUILDING PERMIT ISSUED ------------------- ------------- DATE _----__--_--------_--_------ AIDDITIONALCOMMENTS ------------------------------------------------------------------•------------ ---------------------------------------------------=---------------•----------- li - --------------------------------------- - li - ------- --------------- F nal Inspection by: ------- ----------------------------------------------- -Date �------------ 9---- ' A J06;QUI'N LOCAL HEALTH DISTRICT f li E. . H. 1-'68 Rev. 5M.