71-1188 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: �- I ' APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .77.k_/__/ _F___. ------- ---------- - -------------------------------- I ' F, 7. 'Z9. ________.___ This Permit Expires 1 Year From Date Issued Date Issued __f__________ __ 7 1 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: fJOB ADDRESS/LOCATION J o.. - -- --- ------------ - ----------CENSUS TRACT Owner's Name ------------- Phone �'�_ �_ Address *0C, ` = City -------------- - -------- ---- ---- ----------------------------------- •------ Contractor's Name __.- ------------License #! S'�I______ Phone _ (a -}60 j Installation will serve: Residence Apartment House-E] Commercial TrailerCourt ;❑ Motel ❑Other = Number of living units:-___J----- Number of bedrooms _____::Garbage Grinder ------------ Lot Size __ -_________ -------------------------- Water Supply: Public System and name ________________________ __ ------------------------------------Private i Character of soil to a depth of 3 feet: Sand'D Silt❑ ' Clay-[ Peat❑ Sandy Loam .E] Clay Loam [j 1 - Hardpan-❑--Adobe Fill Material'__ ` If es, type ---------------------------- . "`— Y Yp (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 available within 200 feet,) s ' PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth --------------_--_-------- Capacity . {----------------- Type -------------------- Material---------------------- No. Compartments ------•-- a Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---•---------:•--__ -_ LEACHING LINE [ ] No. of Lines ______________________ Length of each line------__-________.___.______ Total Length ------------ -------------- 'D' Box ------------ Type Filter Material ___________________Depth Filter Material -------------------------------------------- E i Distance to nearest: Well ------------------------ Foundation ------------------------- Property Line _ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---_---------- _ -- _______ Rock Filled Yes ❑ No 0 Water Table Depth ---------------------------------------------.--Rock Size -------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ________---------- ------- _ D to _______.__.____ j� -------------- ) Septic Tank (Specify Requirements) --------_--------_----- __ __________ - ---- ---------- - --------- - -------- --- Disposal Field (Specify Requirements) ----- -------------------------------------------------------------- -- 'f x X I ----r ----r - ------------------------------------------------------ ----------------------- raw existing and required addition on reverse side I I 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 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 r ------ - -- --------•------ ---------- - BY - _---- ---- --- ------------------------------. Title ' {Ifo er t owner) FOR DEPARTMENT.USE. ONLY APPLICATION ACCEPTED _ ---------- ---------------- ---------- . DATE _sem.-_�9-,��---------- • - ---------------------------- - BUILD ING PERMIT ISSUED -------------------- -------DATE ----- ---------------------------------- - TIONAL COMMENTS --------_________________________ --------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- ------------------------------------- - ----------- ----------------------- ---------- ---- --- -- - --------------------------------------------------------------------------------------- --- ----=-- Final Inspection b '- ----------------------------- ------------------ --- - - ---- --------------.Date ---- --tr_- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M