68-761 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR,SANITATION PERMIT s Permit No. ---------- � - -� (Complete in Triplicate) -------------------- ----- ---- - Date issued This Permit Expires 1 Year From Date issued ------- ------------- { rict for a ork herein Application is hereby made to the San in compliance with Cau cal Health EstOrd Hance Nomit4t9 construct sting Rulestaln�Re�lat ons- described. This application is made P- ......... - ------ --- -CENSUS TRACT JOB ADDRESS/LOCATION -.---- ---- , . r _ — Phone - ---- Q ------- -- - -- - -- - - --- ------- - ---- Owner's Name --- Cit ------------------------------------ =R , Address ---- ---- -------- - ------------ - — ---.License # .1D�_�_.L�.__ Phone --------------------- _ Contractor's Name .__.___.-._._ _ _ - - � Installation will serve: Residence Apartment House'❑ Commercial ❑Trader Court ❑ Motel El Other -------------`----- ------ k y � Lot Size ------------------- Number -- ------ ------ ------- -- I Number of living units:____1----- Number of bedrooms -___�- _--Garbage Grinder - -(�-- Private ❑ -- I Water Supply: Public System and name _______________ - - - Clay Loam [] Character of soil to a depth of 3 feet: Sand'❑ Silt E-1 Clay .0 Peat❑ Sandy Loam ❑ � Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type --------------------------- - I {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 availahTe within 200 feet, �� Liquid Depth _- ! PACKAGE TREATMENT { ] SEPTIC TANK:j I Siz __ - f _ 7 e .� = - Material__i�� No. Compartments ----- ---------•------ Capacity �-- --- -- - Yp ` Distance to nearest: Well ----------------------- ------------Foundation t---------------------- Prop. Line .--------- ---------- ` LEACHING LINE +A No. of Lines -- ---- __-- Length of each line.--------?0_.__-- __-- Total Length Al ---- --�------------•-- C 'D' Box ------ Type Filter Material -f- ----Depth FilterE Materiaf _---- ; r Distance to nearest: Well ^- :-==---== = :-- Foundation ---1 -------------- Property Line ------------------------ -�-! if SEEPAGE PIT p Diameter _ - _---- Number _---.---.-1----- Rock Filled Yes No �. Depth ��-------- >, ; r ------------Rock Size '- - f�' r Water Table Depth ----------------- ------- --------- 1;6 '--•-----------Foundation -�-------- ---- Prop. Line Distance to nearest: Well ________________-xv-� y ` Date --------------------- _ ' REPAIR/ADDITION(Prev. Sanitation Permit# -------------------- Septic Tank (Specify Requirements) -------- ------ --- ---------------------------------------------------------- Disposal --- ----- Disposal Field (Specify Requirements) ---------- ----------------- •-------------- ---- ------------------------------ - --- ------------11i ------------ ----------------- - -------- --}h-------- ----------------------------------------- --------------------------- (Dra- w existing and required addition on reverse side) I hereby certify that I have prepared this application and thata 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: erson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p i as to become subject to Workman's Compensation laws of California." b - -Owner --Signed _. . _ . I ---------- --- -- ------------- - Title __ _ - - BY (I oth an nerf .' w FOR DEPAitTMENT USE ONLY - DATE _. b--6�•------------------- APPLICATION ACCEPTED BY ----- ------ `------- - - ------D TE -------- --- -- ------ ----- - BUILDING PERMIT ISSUED ---- ---- --- ------------------ --------------------- -- ADDITIONAL COMMENTS ------------- -- - _____ ____ ____ _________fA-__ _ _� _� ._ _ _ -C - _-_____ _____ _____-----_-- --- ____--_____ _--_ ----_ _--- _----- __ �Q - --------------------------------- b. -- . ` --- ---------- Date --- ----- _-- 9 -- - ---------------- -- -- Final Inspection b � v-"_ 1------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M