71-844 - Laserfiche WebLink

Home Browse Search

J FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ........... ------ ---------------- Permit No: --=------------- (Complete in Triplicate) f� p, Date Issued :7.(Y- .1. This Permit Expires 1 Year From 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 compliance with Count Ordinance No. 549 and existing Rules and Regulations: +� --- --------- va�� ,Q ------- ---------CENSUS TRACT _------------------------- JOB ADDRESS/LOCATION .--�._L__�,�.-- -- -- --- �e'-`r - - - Owner's Name ' -- - ---- ------- -------------------------------------------------------------Phone ------------------------------------ F Address ------------ ------ - ----- ------ City ------------ ---------------------- o Contractor's Name _ fi___ -----• --- rrlicense # +f3 Phone Installation will serve: Reside -e ❑Apartment House❑ Comm rcial ❑Trailer Court ;l] Motel ❑Other --r?y-u�_ ------- __ I Number of living units------ ------ Number of bedrooms _>f_Garbage Grinder _______._. Lot Size ---- "'" "' ------------- Water Supply: Public System and name ___ ___ Pp Y Y --------------------------------------------------------------------------------------------------------Private Character of soyl to a depth of 3 feet. Sand'❑ Sift E] Clay E] Peat E] Sandy Loam ❑ Clay Loam ❑ HardpanAdobe ❑ Fill Material - ---------- If yes,type ____________________________ (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 seep a pit permitted if ublic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[� Sizel Y--�---�------------------- Liquid Depth ------------.----- \4 ___ - -- !-- Material--- ------------------ o. Compartments __ ...----__-. Capacity i;6.6 Type _ .. Distance to nearest: Well ___.______•�_ __ _______________Foundation -----t_p----------- Prop. Line ____ ------1-------------- Length of each line_-----�_�.0_.1_.-_---- Total Length __- -U................. LEACHING LINE No. of Linesv 'D' Box ____.____.__ Type Filter Material ------Depth Filter Material ------H--------.-------------.......... _ Property Line _____ Distance to nearest: Well _____ ___.________ Foundation _--19. ............. � - ........... SEEPAGE PIT [� Depth ------P-____----- Diameter _3-�_ Number ________ --�- -��- Rock Filled Yes [ No c I ,� Water Table Depth --------------1� IVA------------------ Size _.YX,2 Distance to nearest: Well ------------/__VA_�________________Foundation -----I_4_r_.____ Prop. Line ........... Distance REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------- ,•_________ Date ____--_-__________________________) Septic Tank (Specify Requirements) --------------------- --------------------------------------------- Disposal Field (Specify Requirements) --------------------------------- -------------------------------------------------- ------------ ------------------ ----------- ----------------------------------------- --------------------------- --------- ----------- ---------------------- ----------------------------------------------------------- (Draw existing and required additiori on reverse side) ' ., I hereby certify that 1 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. Son 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 ---- -- BY -------- --- -- Title ----- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY —/.; ---------------------------- -------------------------------- DATEO'__' - -------------- ---- BUILDING PERMIT ISSUED -------- -------------------------------------------- -----------------------------------------DATE ---- -------------- ADDITIONAL COMMENTS ----- ----- p7-`� 3-. ''------------------------------------ ---- ------------------------f---------- -------------- --------------------- ---------- • - ------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------- - L_1011 Final Inspection by: ----------Date - -- - ------------ - -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M