68-691 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT rs r . Permit No: _ _ _�� ' (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issued " Z6 If--,020 —12-- Application --1.a—Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desc/ ` ribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION Ir .-lV--. _-- --------�--fes--- --..__CENSUS TRACT --•--- --------------- 9 11 Owner's Name s.• b ~� _Jr Y7114—A----�--------Phone -.e -.3��ci.� -- Address _/4-4000--- .C-0 � 1��------------------------------- Citj ��- Contractor's Namer �.c -----"-- `� --------License # Phone Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ,[] Motel ❑ Other Number of living units:--1--- ---- Number of bedrooms -c1------Garbage Grinder f 4---. Lot Size _ cad_t _!qp�7------------------ Water ----.- -----•Water Supply: Public System and name --------------------------------- --------Private [ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandyl. Clay Loam Hardpan ❑ Adobe ❑ Fill Material ko---- If yes, type ----_._------------------- 3 M (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 ge pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [ I SEPTIC TANK' Size-------------------- -------------------------- Liquid Depth --- --------- :----- Capacity Id-----.,_ Type _------------------ Material�� _ No. Compartments __jQ.___________.___ I Distance to nearest: Well -----itDo------------------------Foundation J0-------------- Prop. Line ----------_-:-----_ LEACHING LINE No. of Lines --- Length of each line.. __- ____ ..Q__ Total Length 'D' Box /� ------- Type Filter Material ��_ _- ---Depth Filter Material __._-__1q_ _______________-•------___-_- Distance to nearest: Well _.._S'P------------- Foundation --10_ -------------- Property Line ._- ------_---- i SEEPAGE PIT [ ] Depth _.-- ----- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size --------------------------.----- Distance to nearest: Well --_------------------------------------Foundation -------------------- Prop. Line ------------_------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------- Date ----------------------------------} Septic Tank (Specify Requirements) ------------------------ - ----- ---------------•------------------------------------------- ------ .....Disposal Field (Specify Requirements) __ r4w--_- � ------------------ ----- ------- ----------- -------------- - -------------------------------------------- --- ------------------------------------------------------------------------------- ---- - -- ------ ------------------ ------------------------------------------------- ---------------------------------------------------------- ------ -------------------------- - (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, I shall not employ any person in such manner as to becomesubje to Workman's Compens i n I ws of California." Signed -_�' ' c Owner By --- t ------ ------------------ Title ----------------------------------------- 1 other than owner FOR DEPARTMENT USE ONLY APPLICATION .ACCEPTED V`,-T-1 f'i---�------ -------------------------------------------------- ---------------------- DATE ----------- BUILDINGP RMIT ISSUED ---- --- -----------------------------------------------------------------------------------------------DATE --------------------------------- --------- ADDITIONAEf6MMENTS - -------------------------- --- -- kF -- ---------------------------------------------- --------------------------- --------•------------------------------ - -------- ------------------------ - -- ----- - ---f--F---_-----------_---__---.-----_._-------"------------------------------------------------"-------------- -------------------------- ----- Z ---- --- - ------------------------------------------------------------- --- ----------- ----------------------- - ----- ---------------- - - / - - --------------------Date Inspection bSAN --- -- - ----- JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M