68-553 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------.---'-- -----=-------------------- ----------- I . -------- Permit No: (Complete in Triplicate) ----------_------_----------------------- --------------- This Permit Expires Y Year From Date Issued Date Issued 2(o (--cve —LI Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein' described. This a plication is ade in compliance with County Ordinance No. 549 and existing Rules and Regulations. {tiJOB ADDRESS/LOCATI VU � �{---CE S -F R /�f 0C-- �F L --z--- - __CENSUS TRACT __-C------=------------- Owner's Name ---------a_? 4------------- ------------------ --------------- Phone �-�-,-}-------- - -- Address --- 'CJ-_x------------ - ------- Contractor's Name _-- -_I fes` -e-------------------------------License#Z/. R/f.... Phone ` ---- -• -/•-- Installation will serve: Residence]KApartment House❑ Commercial ❑Trailer ;Fe � Motel ❑Other ----------------------_-------------------- Number of living units:.__I------- Number of bedrooms __-:Z____Garbage Grinder ------------ Lot Size *,14i! e,9_e________________ Water Supply: Public System and name ------------------------- •---••------------- ------------------------------------------•---•--- -----------Private Character of soil to a depth of 3 feet: Sand' Silt❑ Clay _❑ Peat ❑ Sandy Loam ,❑ Clay Loam :❑ Hard an Adobe' Fill Material ____ ------ If yes, t _ [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] 1 NEW INSTALLATION: (No septic tank`or seepage pit permitted if public sewer is available within 204 feet,) 7 PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size_:_ :_ __, _��------- Liquid Depth __7... ______________ Capacity 1/.2-690--- Type &OwY e;Aaterial---------------------- No. Compartments -/ ---------- -- v. ' I �___________________Foundation .____-46 . -_ Prop• Line ___._—Distance to nearest: Well ____ _ _ LEACHING LINE [ j No, of Lines ____I______.________ Length of each line----//_00--------------- Total Length ,___f_Q_G�.'._.....- ' 'D' Box Type Filter Material- Depth Filter Material ------ - Distance to nearest: Well -------------- Foundation -----.-------if)---- Property Line ___________5__._.... SEEPAGE PIT [ ] Depth ____ _______________ Diameter ---------------- Number ---------------------------- Rock Filled Yes E] No i❑ Water Tab_le Depth -----------------------------------------`------Rock Size ---------------- --------------- I 'f Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------------------_.-- ` � REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------- Septic ---_---.-------____-- _ --Septic Tank (Specify Requirements[ ---------------------------------------------------------------------------------- ---------------------------- ••Disposal Field (Specify Requirements) ------------------------------------------=--=---------------------------------- ---- ------------------------------- --------------- -------- - --•-------------------=- ------ ----------------------------------- ----------------------- -- ------------------------------------------------------------------------- ----------------------------------------------------- I-------------------------------------------- --------------------------- . (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 accordance with Sano Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Nome 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 beco subj�ct t�orkman's mpensati.on laws of California." T Signed _ _-- _ - .- Owner BY ----- ------------------ ---------------- --------------------------- Title ------------------------------------------------------ (If other than owner)I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------!777, C?------------------------------------------- -------------------------- DATE ---------- BUILDING PERMIT ISSUED ---------;--i-------------------' DATE ADDITIONAL COMMENTS --------------------------------------------------- ------------------------------------------------- ------------------------- -------------------- ------------------ ------ = ---------------------------------- - --------- - ------ - -- ----=------- Final I n b L -------.Date = --•------- SAN JOAQUIN LOCAL HEALTH DISTRICT F. H. 9 1-'68 Rev. 5M