73-691 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT Permit No. .......--................-....................... (Complete in Triplicate) 'z. ....................................................... Date Issued ..9.......�:�.. ........... 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION t��.. ......-- --•--- -..... CENSUS TRACT .......................... Owner's Name ......................r--------------------------- ....... hone .�, f .�%�� ........ . . .. .. ....t .... city � � ...................... Address .............1 .. -.....--- Contractor's Name -r-------------- License # . q� ! ._ Phone .............................. ............... . ..... Installation will serve: ResidenceApartment House❑ Commercial ❑Trailer Court 0 Motrrrj Other .................-------.....•------------- Number of living units-----f..... Number of bedrooms ------ Garbage Grinder __..--- Lot Size ...... �----- _.......... ......... Water Supply: Public System and name ...............................................................................--..............................Private Character of soil to a depth of 3 feet: Sand 0 _Silt[I Clayy❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan E] Adobe Fill Material ............. If yes,type ---------------------------- (Plot plan, showing size of lot, locatiom of. system in relation ta=wells, buildings, etc. must be placed on reverse slde.),-, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK Size... ................. Liquid Depth .. -------------- 6 Capacity -~- ..._ Type .. . --__ Material._ .: No. Compartments ....L ........... Distance to nearest: Well .:.-...rid-..................Foundation ......ID.......... Prop. Line __S`. ......... lit i LEACHING LINE No. of Lines ---------(............. Length of each line----------- ........ Total Length ......71-�.... ........._. V Box .._-✓.. Type Filter Material . Depth Filter Material ... -. �. ...r..................... Distance to nearest: Well -------S.......1 � — .... . Foundation -...--1.�._.f..... Property Line ...� .. ...........= SEEPAGE: PIT Depth .._.?i,S..._ . Diameter ._d --- Number .......... ........ '.... Rock Filled Yes No Water Table Depth __ - Rack Size/Y---X- -...__. -• . ..................•--... ... f Distance to nearest: Well .......f ft........................Foundation ...L6....L6.7.1..... Prop. Line _- _ ....... REPAIR/ADDITION(Prev. Sanitation Permit# ........................... Date .................................. Septic Tank (Specify Requirements) ---------------------------------- w......................�.1. _.. Disposal Field (Specify Requirements) -----� `x...... -_' ------------------------------------------------------------------------------------------------- ------------------------------------ ------------------------------------.......................-.---.........-...................... ...................................................... (Draw existing and required addition on reverse side) 1 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 Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify, that in the performance of the worn 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 ------------- ;Title -----... . ................................................... (If other an owner) FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .....- c......----------------------------------------------.............- •.._ DATE ...F�Xt ... BUILDING PERMIT ISSUED ....... ---•-- •- . ..................--------...........................................-...........DATE ... .....------........... ADQWMNA COMMEN .... .. ......... ....... ............................................•------------------------•------..............--------.........._.._... ..3.. ----- ..---.............................. . ............. ............... ........ --------- . ----•- -• •............:...........•------••----•-•......-..------------............••--•- --• • . - Fina( inspection by: ...:. ... -• --- -- --- ------••-•..................•-...-----•---................••..•......._.Date ..- .. �� QAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'68 R . 5M 7/72 3 M