70-50 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USD: APPLICATIONFORSANITATION PERMIT Permit No. --------------- (Complete _ _v--(Complete in Triplicate) - ------ A - This Permit Expires 1 Year From Date Issued Date issued _A_-c:2-20 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: JOB ADDRESS/LOCATION ---_---- - C� ]1!---------------------------.}_V.Q ` CENSUS TRACT _5_757)------ JOB II ,t} Owner's Name - -----� '�'=� r 4 _£' ,-' Phone ----�' -�'-------- ! Address l --�4 h--f' -- n ----- -'4 -_: E icense.#.r :� :.__ Phone Contractor's Name _.______.___-X- -_---- -- # Installation will serve. Residence ®-inC7pa-rtment House.❑ Commercial:❑Trailer Court ❑ Motel , Other --------------k------ :----------- Number of livingunits..--./----- Number of bedrooms �.__ Lot Size -_-- -- --- - ©n :-^ .____Garbage Grinder Water Supply: Public System and name _______�- ___ ----'_ - ----------------------------- Private �]-- Character of soil to a depth of 3 feet: Sand;[) Silt C] Clay .❑ Peat❑ Sandy Loam �C1ay Loam ` -Hardpan,❑ •Adobe❑ Fifl TNaterial �'"_`'If:yes;Type __--____- (Plot plan, showing size of lot, location of system in relation to wells, build'+ngs,",etc. must .be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage'pit permitted if public sewer is available within 200 feet,) SEPTIC TANK Size--------------------------------- ------ ------ Liquid Depth -----------------•-- PACKAGE TREATMENT { ] [ ] Type Material-------------------- No. Compartments ------ ---------- Capacity -----.------ YP Distance to nearest: Well : ------------------------------Foundation --- ------ Prop. Line _ • .-. f LEACHING LINE [ j No. of Lines --------------------- Length of each line------------------------ Total Length •--- ----------- --- -- --- 'D' Box ------------ Type Filter Mcterial --------------------Depth Filter aterial -------------------------------••------> Distance to nearest: Well -------- --------------- Foundation ----------,----- ------ Property Line. -------------------.-•-- SEEPAGE PIT [ ] Depth __ Diameter ________________ Number -------------------- _____ Rock Filled Yes ❑ No I❑ Water Table Depth -----------------------------Rock Size ------- •----------------------- Distance to nearest: Well -------- ______Foundation - --------- --- Prop. Line ______________________ REPAIRfADDITION(Prev; Sanitation Permit# ------------------ ------------------------- Date --------------- -------) Septic Tank (Specify Requirements) ----------------------------------- -------------------------------------- Disposal Fiel,,, {Specify Requiremen s) _______ ------ ----------------------------I------------ - -- ----------------------------I------------ - ------ -------- -- ---------- ----- ----- ---------- = ------------------ (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 I 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 beco� ubject * Workman's Compensation laws of California." t Signed —� Owner `' --------- Title ----- ----- { other than owner) FOR DEPARTMENT USE ONLY ' DATE / Z ©- -------- APPLICATION ACCEPTED BY _�_Vkk�a------------------------------------ - fi BUILDING PERMIT ISSUED ----------------- -------------DATE -------- ------------------- - - ADDITIONAL COMMENTS ---------------------------- --------------------- r _ ----------------------------------- - ----- ------ --------- ----- --------------------------------------- : "`� - ----------------------- Final Insp ----- ----- ` ----•------------------- = Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M