70-885 - Laserfiche WebLink

Home Browse Search

' .. ' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �. "- Permit No. (Complete in Triplicate) ---------=--e------ _--------� ` This Permit Expires 7 Year Front Date Issued 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 corwliapce with Cour Ordinance No. 549 and existing Rules and Regulations: --------------- -- ------------------- CENSUS TRACT -------------- ------ JOB ADDRESS/LOCATIO _ Owner's Name - Phone Address ---------------------- -------- City ��/�/--//'' ------------ Contractor's Name --. -- __-- _- - -- License # ��©,�/1---- Phone _7 12__- _-___. Installation will serve: y Residence ❑ Apartment House-0 Commercial �❑Trailer Court ❑ 5 Water Supply: Publics stem %, Community system Private Depth to Water Table _Sft. , r-'{--oar nF -;1 4- a A-4L -4 9 1-1- Com. 4 I-i C;ra...,l r-1 C�,..d, i ..s...`r-7►,, � I y 1 r`l-.. I"i A.J..4... rG�' LJ.....J....._ r-1 Water Supply: Public System and name --------------------------- [ '-C /[l r------!k4m -------------------------Private❑ Character of soil to a depth of 3 feet: Sand'❑ Silt[I Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam n'4 Hardpan F-1Adobe 14-NII Material ---------.__ If yes, type _______________________-- 7� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) j� NEW INSTALLATION: (No septic tank or pa a pit permitted if public si sewer is available within 200f et,-) PACKAGE TREATMENT [ ] SEPTIC TANK* Size_x&&_^�'_- ----------- Liquid Depth _______________--__,___- Capacity Material_ - o. om artments •�- 4Mce to nearest: Well ._ __ _____Foundation �_ _________ Prop. Line�`______________.�.._- -------------------------- -Vl LEACHING LINE Lines ------------------ ----- Length of each line______-_.___-._- Length _____:__________.._.s.;; 'D' Box ------------ Type Filter Material --------------------Depth FiltertMaterial --------------------------------------- Distance to nearest: Well ------------------------ Foundation -_ _____':__- Property Line _______________ _____ _ f ' SEEPAGE PIT [ 1 Depth -------------------- Diameter ______________ Number __-__________. ____________ Rock Filled Yes ❑ No 0 Water Table Depth-------------------------:t------------------------Rock Size -------------------------------- , � - t Distance to nearest: 1l'- --------------------------------Foundation ------------_.----- Prop. Line --------------_--.-.. REPAIR/ADDITION(Prev. Sanitation-Permit# ----'-------------------------------------- Date ------------ -----..--------------} j � T ' = Septic Tank (Specify Requirements) ____ ----_------------------- ----------- -------------- -- s � Disposal Field (Specify Requirements) ___-__� _+`_-_ __ x__ __ _ s,� ! Y - --f -'rte -- ---- -- --------f--------- ------- -Q�----------------- ' ` --------- ---- -- - ------- - ----- - -- (Draw existin 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 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 tome subject Workman' Co sati laws of California." Signe -al- +_ •.et 1 __7-- u BY -- ---- --- Title __ S /llC�l��._.. (If other than owner) FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY _- _____ ___ _ DATE ----------- BUILDING PERMIT ISSUED --------------------------------- ---------------------- DATE ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------------------------------------------------------ ------- ----------- - - ----------------- ----------------------------------------------------------- --- ------- ------------------------ Final Inspection by: ----------------------------------- Date / ----�( -- - SAN 16AQl71N LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M