71-490 - Laserfiche WebLink

Home Browse Search

-FOR OFFICE USE: �` APPLICATION FOR SANITATION PERMIT : _ -� (Complete in Triplicate) Permit No tw qla---- ________ _____ This Permit Expires 1. Year From Date Issued Date Issued 57z/--71 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 Count Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION __ �_ u. . -- - - - NSUS TRACT -------------------------- Owner's Name ---------�-------- - 1��.._ - - Phone66U Address - -- ---------------- -- -------------------------- City •--------------------------------- `S '------ ��------- moi/ i�4f6-- 60 91 Contractor's Name ----- --- ---'---'---_-� _ --- - __.License # ��'1_______ ________ Phone _7_.__ - --�----.7_--_ Installation will serve: Residence ❑Apartment House,❑ Commercial ❑Trailer Court i Motel ❑ Other Number of living units:.___-____ Number of bedrooms ______Garbage Grinder __---___.__ Lot Size --_ _ ______________________________ __ Water Supply: Public System and name ------------------------------------------------------------------------;--•---------------- -----------------Private F71Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material _ _� If yes, type ____________________________ {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be ,placed onsreverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted ifpvbli c'�sewer is available within 200 feet,) �+ PACKAGE TREATMENT { ] SEPTIC TANK'[ ] Size__________________________________ Capacity -r--- Type ------ --------.=-- Maferlal_____�----' No.�Compartments \------_------ Distance ; nearest. Well ----/-----------------------------•Foundation ---------------------- Prop. Line --_`--- .----, �I LEACHING LINE' [ J No. of.Li% -----------------(length of each line--___________._______.____ Total Length ------------ ----------------- ___� ' 'D' Box _ __ a___XType, Filter Material ____________________Depth Filter Material ___---.___________ I Distance to nearest:-' el,l w: _ -_________________ Foundation _____.______--_-______ Property Line ________ .____ a SEEPAGE PIT [ ) Depth ______.____ ------- Diameter ___- �_.�'�_• Number ---------------------------- Rock Filled Yes {] No Water Table Depth --------------------------- � ---- -�, �---------------Rock Size -------------------------------- { l� -_ `�'T "' Foundation Distance to nearest:'We11 -------------------------- -------------------- Prop. Line ---------------- REPAIR/ADDITION(Prev, Sanitation'P`ermii ----------------------------------- Date -----------------•----------------] Septic Tank (Specify Requireme s)'�-- - �- Disposal Field (Specify Requirements) -- - 7 Ca- ------------------------------------ _ _ -------- ------------- ---------------------------- ----------- ------------------------- -------------------------------- _ (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 .a corE dance with,Sa J quip i 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 an" y person. in such manner as to become subject to Workman's Compensation laws of California.'-'� Signed ----- ----'---------'-- ----- ----- ----" ----- - --- - - 1-- O�ner� BY --------------- -------- -- - --- '' ' "�' .......-- --„- ---------j Title �-- � -------- --------------------------- (If other tha ner) 0� { " DEPARTMENT LESE ONLY APPLICATIONACCEPTED BY - ----------- - ---- --- --- -------------- ---------------------------------------------------• DATE ------------------------------- BUILDING PERMIT ISSUED--' _ , 1. '_ ---- ---- - ------'` -- DATE ----------------- - ADDITIONAL COMMENTS - ______ 3 - , i ---=------------------------------------------ ---------- ---------- ---------------------------------------------------------- - ------------------------------------------- = i �( ---------------------------------- -- - - Final Inspection=by:'d. t ---------------- --- ---------=--------------------------Date - - -- -- - - - - 5AN/JOAQUIN LOCAL HEALTH _DISTRICT (w/ E. H. 9 1-'68 Rev. 5M. �J 1