73-89 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ` APPLICATION FOR SANITATION PERMIT ------------------------------------- lComplete in Triplicate) Permit No. ------------------_____________________________________ This Permit Expires 1 Year From Date Issued Date Issued 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 ----------35ci-q---. ll`✓J------------------------------------=--------- - --CENSUS TRACT ---- ----------- Owner's Name -----JAum-------------Fisro4geA--------------------------------------------------------------------------- --Phone._(09Q3?57 -119 3. Address -------------------- ------------------- 1 UInX.11-------------------------------------------------• City ....blqmwe----------•------------------------------------.._.-__ Contractor's Name ---------------------- ------------------------------------------;-------.License # ---------- -- ----------/- Phone ------------------------------ Installation will serve: Residence E]Apartment House Commercial ❑Trailer Court ;E_ Motel ❑Other -------------------------------------------- Number of living units:--- Number of bedrooms ---0------Garbage Grinder ____r-__ Lot Size ____y7 _._ ------------------------- Water Supply: Public System and name __�iCz -------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ Hardpan ❑ Adobe Il 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,) In PACKAGE TREATMENT [ ] SEPTIC TANK f-r' Size___________ -------------- Liquid Depth ------------- _f t n - ..�. Capacity _la ____,___ Type _I &� Material-Ca)2C4A-L¢-__ No. Compartments Distance to nearest: Well ------ ------------------Foundation -___------- Prop. Line .............. LEACHING LINE [ ] No, of Lines ---- ------------ Length of each line--------30_------------ Total Length D' Box _ __'._ Type Filter Material -------Depth Filter Material ______ ............................... - -- Distance to nearest: Well ___1ro --------- Foundation ---- /0 Property Line ____ __________________ SEEPAGE PIT [ ] Depth _____"__ Diameter ________________ Number ------- -------------------- Rock Filled Yes ❑ No Water Table Depth --------------------------------------- ----Rock Size -------------------------------- Distance to nearest: Wel! ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ________._________________________J SepticTank (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------•-------- DisposalField (Specify Requirements) ---------------------------------------------------------------------------------- -------------------------------------------------- ---------------- -4,------------------------ -------- ---------------------------------------------•------------ ---------------------------------------------------------------- - - - - --- - (Draw existing and required addition on reverse side) 1 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`'sigtiatuie 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 WsvknTWs mpensation laws of California." Signed - ------------------------ Owner BY ------------------ ----- - ---------- -------------- ------------------------------ - Title -------------------------------- --------------------------------------- (if other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE ---- � 7 ------------------ ------ -------- ---------------- --- - -- BUILDING PERMIT ISSUED -- -------- ----------------------------------------- ADDITIONAL ------ DATE ADDITIONAL COMMENTS ---------------------------------------------------- ------------ ----------- - ---------------------------------------------;--------------------------------------------------------------------------------- ----------------------------------------------------------------------- - ---------------------- ------------------------------------------------------------------------------- ------------- - - Final Inspection by- ------------------------------------------------ ---------------------- -------- J` j j --1Date _-o" -_ �" F ---- --- SAN JOAQUIN LOCAL HEA DISTRICT ,{ E. H. 9 1-'68 Rev. 5M f ;