72-545 - Laserfiche WebLink

Home Browse Search

~ FOR OFFICE USE: f" ' APPLICATION FOR' SANITATION PERMIT Permit No: .7_z_'_ _ __5 (Complete in Triplicate) ---------- ........A( -------------------- Date Issued / This Permit Expires 1 Year From Date Issued --------------- ------------- Application Application is herebymade to t e 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 Mules and Regulations: -5.-----fitll---------A_G� -'-----------------CENSUS TRACT -------------- ----------- JOB ADDRESS/LOCATION ----67/. Owner's Name _-L.l�_L3-L.I_ _ '�-------:T-1-------6-Fl F Phone.`? -�✓. L C AL�_t�_- 9S3`7fa------- Address ..__ �- ---=-------- --------------------- ------------------ city � `� ! - --- - 1 ---------- ---------------- Contractor's Name - ------I--------------------------------------------------- -----License # ------- ------------ -- Phone --------------------_ - Installation will serve: Residence Ng Apartment House- Commercial:❑Trailer Court '❑ Motel ❑Other -------------------------------------------- Number of living units:--_1--------- Number of bedrooms ____:S__...Garba_ge Grinder -----L----- Lot Size _-------------_----_---_--_-_--_--: ------ Water Supply: Public System and name ------------------- - ------------------------------ ------------------------Private t t tR Character.of soil to a depth of 3 feet Sand❑ Silt F1Clay E] Peat F-1 Sandy Loam ❑ Cay Loam Hardpan E] '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.) NEW INSTALLATION: I (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT P< SEPTIC TANK' ] Size-----------------------`- --- -._ Liquid Depth -------------------------- V.Ir . .n Ca acit --- Material- No. Compartments ______________________ W p Y --- Type, _ ----- . Distance to nearest: Well -.- _` ---------------- u Fondation _ --------------- Prop. Line __..____._:_____....-- LEACHING LINE pQ No. of lines .0� _ Length of each line ------ 9 ------ Total Length ---�'� --------•----•• •: �- 'D' Box ---�.----•Type Filter Material - -- - • -�epth�"Filte lillaterial"""`_"-`-------------- ------- -- r ...._-_ Foundation --PC?., -__.i---___ Property: Line J Distance to nearest: Well _��_�_'___ Js-----""---"""- SEEPAGE PIT [ ] [ Depth _ Diameter Number ._ _ Rock Filled Yes ❑ No ❑ ------------- --------------- ------------------- - Water Table Depth ------------ Rock Size --------A-=---- ------••------ i Distance to nearest: Well -------------------------- ------------Foundation -------------------- Prop. Line ---------------------. ' ----------- Date ------------------- ) f REPAIR/ADDITION{Prey. Sanitation Permit# --------------------------------- -----�-- Septic Tank (Specify Requirements) --------------------- = y 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 ce �""-'"�rtifies the following: I € k "I certify that in the performance of the work for which this permit is issued,,Vshall not emp];oy any person in such manner as to become subject to Workman's Compensation laws of California." —.• - }C �` �O l �9 ' (C,l.X4-- --- ----- Owner Signed f 4 -4 I ------ Title --- -------------- -------------=:------------------ ---------------- (If other than owner) .FOR..-DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY --- - ------------------------------------------------- ----------------- --- DATE -------�-- - ----------------- BUILDING PERMIT ISSUED ---- --- -------------------- DATE ADDITIONAL COMMENTS ----------------------- ---------------------------------------------------------- --------------- -------------------------------------- ----- - ----- ------- ------------------ -- ---- ----------------- -------------------------- -------------------------------------------- - - Fin ---------- Final Inspection by: ------- Date 'SAN "JOAQUIN LOCAL HEALTH DISTRICT . J E. H. 9 1-'6$ Rev. 5M. '' :. i,' .s� -'' �� ;'.F1'It