71-292 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ---- ---------------------------------- Permit No. a . (Complete in Triplicate) _ ___ ---------------------- ---- This Permit Expires 1 Year From Date Issued Date Issued 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/LOCATI N fp ,[_Y__`---- --------- ,Z- -' ------- 1 CENSUS TRACT 5 a ' '/�`•C !' C'fd 6 Phone ---------------------------- Address ` Owner's Name -------------� -- ---------------- - ----------------------- -------------------- Address -- -- -�-------------- , .___. City - / - - --- Contractor's Name ---- / OVZf'------------------------------------License.# ---------:-------------- Phone ----------------------------- Installation will serve: Residence [�r_Kpartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other ------------------------------------------- Number of living units:__/__-__ Number of bedrooms ---Z-____Garbage Grinder AIV---- Lot Size *e--__ i��__ ___________ Water Supply: Public System and name ------------------------------------------------------------------------------------------------------•----• Private• Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam �� Hardpan Adobe ❑ Fill Material ------------ If yes, type ------_---------------______ f S (Plot plan, showing size of lot, location of system in relafion 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 [ I SEPTIC TANK f41-l' Si 7-_X_�r -- Liquid Qep thy.--'-'----------------- ----------- Capacity TypeCompartmentsv► _ ____ Materia No. _ ___;________________ Distance to nearest: Well ------441:pl_________ ----__Foundation _A0- ------ Prop. Line ------- LEACHING LINE Vr No, of Lines ..../---------------- Length of each line_/4011r_____--______ Total Length 1_169wf_-_______-____ D' Box Type Filter - : sMaterial�Materia/ _ hl ------- Distance to nearest: Well -- �______________ Foundation �� Property Line. _� __________...._._. ----------------------- SEEPAGE PIT Depth ��--------- Diameter �--_---_ Number ____�_______________ Rock Filled Yes No Water Table Depth -------/-� ---------------------------------Rock Size --."----------------------- Distance to nearest: Well -___ _____________________Foundation __/� __ Pro Line __-�, 1 - P• REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) ----- ----------------------------------------------------------- ------------------------------------------- --_•----------------- ---------- A Disposal Field {Specify Requirements) ----------- -- - - ____-__________________:_______________---_-_-_______-__ } - - #. - ----------------------I-----------------------------------------------------------------------------------------------------------------------`------------------- ------------------------------------- (Draw existing ------------------- ------ (Drawexisting and required addition on reverse side)• i I hereby certify that 1 have prepared this application and that the work -will be done in accordance with San Joaquin f 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 -------- ----------------- ------ ------------------------------------- Owner I 1" By '---- ---------------------------------- Title �= -- - ---- {If oth an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY J_ DATE _ "_1P'_Z1__________________ BUILDINGPERMIT ISSUED --------------------------------------------------------- --------------------------------------------- ---DATE -------------- ------------------- ADDITIONAL COMMENTS --------,F-________________ ----------------------------------------------------------- --------I----------------------- ------------------------------------------------------------- ---= --------- ------- -------------------------------------------------- ------------------------------------------------------------------------ -------------------------- ------------ --------------- __________________________________ - __�_____ _ _______-_._____ - -4-------------------- Final ------------------ Final Inspection by: ______/'___ ___ _ _ Date _ __.`__ SAN JOAQUIN LOCAL HEALTH DISTRICT ; y E. H. 9 1-'68 Rev. 5M r*i