68-498 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: x - --------- ------------------------- .. - APPLICATION FOR SANITATION PERMIZ ------ (Complete in Triplicate) . ,._. ��Date Permit No �_------- -- This Permit Expires i YearProm Date Issued Issued Application is hereby made to the San Joaquin Local Health District fora described• This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: _ - --�.----- Owner's Name _ - - t CENSUS TRACT, ;.--- I Address L, _ # 7� ------- - --------- ----Phone f -------- Contractor's Name _ ' " City - -- - --- ------------- ------------------------_-- Installation Installation will serve: -----------.License # _ `,r ------------ � m Residence ��'`�-f,�q--- Phone ��/�.f.�, , ❑Apartment House ----- ;: f ❑ Commercial:❑Trailer Caur Motel ❑Other -__--___ , Number of living units: A �_ umber of bedrooms __________.,"Garbage Grinder _____.__ _,Lot Size --------------------------- Water Supply_ Public System and name ______ - -------------•----- Character of soil to a depth of 3 feet: Sand ----------------------------------------- - ❑ Silt „-. - ----•------•--------Private ,- ❑ Clay ❑ Peat❑ Sandy Loam Hardpan ❑ Adobe y ❑ Clay Loam.❑ _ If es - Y , tYpe . --- r ` Fill Material _ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, mus NEW INSTALLATION: (No septic tank or seepage t be placed on ,reverse side)� '(A P PACKAGE TREATMENT Pit permitted if public sewer is available within 200-feet,} ;' 1 SEPTIC TANK[ ] 46\( . Size_ --------•--------- Liquid Depth F'�t Capacity -- �--- --------- - Type -------------------- Material No. Compartments . Distance to nearest. Well _"-- _ _- t LEACHING LINE ----Foundation ---------------------- Prop. Line"`_--------- _ L No. of Lines ------------------------------------------------------------ _______ ___ ___________ Length of each line__ _.__ 'D' Box .......r----- T ---------------- Total Length Type Fitter Material ---"__-- ----------------•- ----` ------,----Depth Filter Material -------__ " ` Distance to nearest: Well ---------------" _ ' SEEPS � ) Foundation Property Line Depth ----- Diameter . + ----------- � _ -- -----�_!_ Number ---- . = Water Table Depth ____ ' � Rock Filled Yes No 0 f p S--Q--------- ---------- =--------Rock Size ----�'^ �� .� Distance to nearest: Well -� �__ --------_ � --:------- 1 t Foundation ' - REPAIR/ADDITION(Prev.'Sanitation Permit# ________ _____" Prop. Line .��-----, . Septic Tank (Specify Requirements) ----=-------- ------------------------ Date --------•------_ l Disposal Field (Specify Requireme ---- ----------- --- -------_, - i ---- - ----------- 1 t --------- ---- ------- ---- - ' ------------------------------------------------------- _ -------- f ----------------------(Draw existing and red ------ ------------------- hereby certify that I have prepared this appl cat an and Ithatathetlwo k will be sided ' on on rev County Ordinances, State laws, and Rules and Regulations of the San Joaquin local Health District. be done in accordance with San Joaquin ` Home owner or Iicen- 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 as to become subject to Workman's Compensation laws of California," Sig d --- ---- ' manner ---- - ------ B - -- Owner -------------- - (if other'than owner) Title -- . --____ -- ---------- PARTMENT USE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED aCcl�l� __ "--__-__ DATE _ -�^- � DATE ADDITIONAL COMMENTS ( ----� - `3----------------------------- --- ~� F;nal 1 spec ion b j - - ------ --- - -------- ------- ---------------------------------------------- - - ----- -- - - ------- ----- ----------------.Date -- �!+` �+ roe SAN JOAQUIN LOCAL HEALTH DISTRICT y '� J F c p� :� E. H. 9 1''68 Rev. 59L. 'V& & %th'