73-166 - Laserfiche WebLink

Home Browse Search

i FOR OFFICE USE:Z. APPLICATION FOR SANITATION PERMIT Permit No. - `/6-4 (Complete in Triplicate) Date Issued _X1_ - �1 9 1:-1_ 3. _____________________________________________ __ __ This Permit Expires 1 Year From Date 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: nn ---- �� ---- .------- ----------------------CENSUS TRACT --- ---------- ........... JOB ADDRESS/LOCATIOyyN _.__....__�_f__��_-_-__._[�_ - Owner's NameQ5_ t�- ---------------------------------------------------------Phone Address ---- ---.�6-73-------- r . ems .1ct of J �. �} City � � Contractor's Name ----- ---- -r � d�r�e� ------.License ----- Phone Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court ',❑ r Motel ❑Other -------------------------------------------- Number ------------- ------------------------ --Number of living units:---- Number of bedrooms ---3-----Garbage Grinder ..... ._.)(.--_ Lot Size ,I-- ________________ {- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobes 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) / � PACKAGE TREATMENT ( SEPTIC TANK [ Size----------SjXle_ � � Liquid Depth ..... . Capacity ----- Type _-� ---- Material jf ,ve_j No. Compartments Distance to nearest: Well ------------------------------------Foundation ...`4-_`--------- Prop. Line ----1¢Z-------- LEACHING LINE D}- No. of Lines ----------1-4------- Length of each line �_`��_--__ Total Length _17o1_f- Z ...__ 'D' Box ----(....... Type Filter Material Aep � ---____De Depth Filter Material ----------- Distance to nearest: Well ------------------------ Foundation --------r-a-__-------_ Property Line __ -°.__-__-___._..__ SEEPAGE PIT Depth --- _r-------- Diameter 340 �- _`'---_ Number _.__._- --------------- Rock Filled Yes No Water Table Depth -----------------------------------------------------------------------------------Rock Size ------ _ Distance to nearest: Well ________________________________________Foundation ---l-d------ Prop. Line ............... REPAIR/ADDITION(Prev. Sanitation Permit# ---------------- _---_----_-- Date __________________________________) SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------•---------------.----------------------------- 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 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." Signed ----- ------------------------------------------------------------------------------------------ Owner BY ------------------------------------------------------------------------------------------------------- Title ------------------- - (Ef other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- - - ----- --- = DATE . --- Z ---------7 BUILDING PERMIT ISSUED - ---- -------------------- ---- - --- -------------------------------------------DATE -------------------------------------- ADDITIONALCOMMENTS ------------------------------------------------------- ------------------------------------------------------------------------------------------ --- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- ------------------------------ --fIN --------------------- --- Final Inspection by - Date '� -- --------- ----- - - --- SAN JOAOCAL. EALTH DISTRICT e E. H. 9 1-'68 Rev. 5M