69-94 - Laserfiche WebLink

Home Browse Search

'FOV OFFICE USE: Iy p APPLICATION FOR SANITATION PERMIT �- ------------- --- "- --------- I� ` (Complete in Triplicate) Permit No. ___._____ _________. ------------------ ----------------------------------- _ _ i!___ This Permit Expires ] Year From Date Issued Date Issued -------------------- =� - r Applicatibnis-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. P9 and existing Rules and Reg lotions: JOB ADDRESS/LOCATION ------------ ----- ---------1-1...............f---------- ------------------ ---------CENSUS TRACT ------ ------------------ Owner's Name ------ ------ �} �!_�1 G- 4 �c 1- ----------------Phone-'----------------------------------- k Address ._.. City -' r--------------------------------------- Contractor's =`f Contractor's Name --------_'__--4-----_16?_ •________ ______ _______ ------- -------------------- --- Phone Installation will serve: I Residence ❑ portment House❑ Commercials❑Tr oiler Court ❑ ��; "Motel ❑Other -------------------------------------------- Number --------------------------- -- Water rSupply: Public System Number of bedrooms ____________Garbage Grinder .__'______ Lot Size ____________________________________________ Y" um er o ivin units:------- and name .____________ _ ._.____Private ❑ ----------------- --------------- --------------=------------ ----------------------- - Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay .❑ ;Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot ________________ _ ___ ___(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 seepage pit permitted if public sewer is available within 200 flet,)' PACKAGE TREATMENT SEPTIC TANK[ ] Size------------------------------- Liquid epthD ------------------------ Capacity ------------ Ca- acitY -- "- -= Type -------------------- ----- ---- afie�rla�. = ' --- No. -Compartments ---------- Dis�nce to nearest—Well Foundation = ___.______________-- Prop. Line---------------------- LEACHING LINE [ J No. of Lines __._____-_________'___ Length of each line_. ___ __.____ _________ Total Length ----________________�__...__ ,1. , .- D' Box __________, Type Filter`Material -----------------_ Depth Filter Material ---- ------------------ Distance to nearest: Well "`.=_=-F :�Foundatlon =� ____--------- Property Line. ---------_ SEEPAGE PIT [ ] Depth ------------------- Diameter ------:r�umber --------- ____-Rock Filled Yes 0 No C k Water Table Depth J_____ Rock Size Distance to nearest: Well _________T_" ,___ Foundation -------------------- Prl*.. tine ___-___-___ ...... ❑tion-Permit# ------------------------------------------- Date ----------------------------------1 R il- tic Tank (Specify Requirements) REPAIR/ADDITIONp (Prw. San' --- ----------------- ---`---------------- ` Disposal Field (Specify Requirements) ------------- a b ` r --------- II -I a (Drew existing and required addition on reverse side) I hereby certify that 1 have 'p repared this%application and ithat the work will be done in accordance with Scan^Joaquin County Ordinances, State Caws, 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 become subject to Workman's Compensation laws of California." f ---- 1 Signed ------------------------------------------------------------ Owner 7. i. BY = --------- ----------_ i'------ -- ---------------`---- Title --------------------------- - - ---------------------------- -------- ------------------------------------- '(If otherthan owner) 'I FOR.-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- -------------------------------------------------------------------. DATE --------- ---------0 :------------ BUILDING PERMIT ISSUED ---------------------------------------- -------------DATE ------------ -----------------'-- ADDITIONAL COMMENTS -- 11------------------------------------------------------------------- --------------- ----------------------------------------------' --------------------------------------- ------------------------- `> Final Inspatiarl by: 'y Date -------r--- ;. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. .r 7