68-1036 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: (V 4 1 C-0 Com' A FOR SANITATION PERMIT , ;/ ------------------ ------- (Complete in Triplicate) Permit No. ---------=---------------------------------------------- Date Issued/-_--Y�:_-68/ ____________._______-__--______-__-____-___.--- 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 County Ordinance No. 549 and existi n Rules and Regulations: JOB ADDRESS/LOCATION .__L /V_�� ___ .___ .1-�n^2 -___CENSUS TRACT __-_______-_..___-_----- Owner's Name p ---------------------------------------------------------- -------Phone Address --------RC1. mf----------------------------=-------------------------------------------------- ------------------------------------------ --. City ---------------------------------------------------------------------------- Contractor's Name - --------�--T s-------------------------------------------.License #L7_-7-g g-3----- Phone 4X_f_-J'2 74--- Installation will serve: Residence [Apartment House❑ Commercial:❑Trailer Court ❑ Motel ❑Other ------- --- �--------------------- � i a c� Number of living units:______{___ Number of bedrooms _f---------Garbage Grinder�____ Lot Size ___________.__._________________________ Water Supply: Public System and name ------ ------- --------------------------------------------------- •-------- ------Private El Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;g-- Hardpan ]t, --'Hardpan ❑ Adobe ❑ 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.) N� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size_____— H ,� s` Liquid Depth -_-_--------------------- Capacity Type _I cAP/-Material_-- _mac No. Compartments __2..... ......... Distance to nearest: Well ________ _______________________Foundation Via__---------------- Prop. Line ........ W LEACHING LINE [ ] No. of Lines ---/------------------- Length of each line----- 19------------------ Total Length ,irk_--_ . ------ `p 'D' Box _____ Type Filter Material '7'-C-A-------Depth Filter Material ___-._-__-.- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ___-____-_----_-..._.-.- SEEPAGE PIT [ ] Depth _________________ Diameter ---------------- Number ____________________________ Rock Filled Yes ❑ No 0 WaterTable Depth -------------------------------- ---------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation ____________________ Prop. Line _._-_____-.._._-_._._- ` REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) Septic Tank (Specify Requirements) ------------------ -------------------------------------- -----------------------------------•------•--- Disposal Field (Specify Requirements) __-__-_--___ ____________________________ --------------------------------------------------------------------------------------------------------------------------------------- (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 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----____ _ Owner ------- --------------------------------------------------------------- By ----------- -"o ------------------------------- ------------------------ Title ----------------------------------------------------- ---------------- (If other than owner) ''..11 _ - 11-l j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----w_�- ,__ (t--------------------------------------------•-------------------- DATE ---_�--y _6.f ------- ----------- BUILDING PERMIT ISSUED ----------------------- --------------------DATE ------------ ---------------- ADDITIONALCOMMENTS -------- ----------- ------------------------------------ -------------------------------------------------------------- ----------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ---------- ------------------------------------------------------------------------------ --------------------------------------- - ------------------------------------ ---- ---------- Final Inspection by: ------------------------ ------------------------------------------------------------------- --------Date -- 1 � ``� 5 SAN JOAQUIN LOCAL HEALTH D RICT E. H. 9 1-'68 Rev. 5M