74-413 - Laserfiche WebLink

Home Browse Search

FOR OFFICE ISE: (0- APPLICATION FOR SANITATION PERMIT _ �� (Complete in Triplicate) Permit No. _..�. ... r - ThisPermit Expires I Year From-Rote Issued Date Issued 2.. �� Application is hereby made to the San Joaquin Local Health District for a'^permit to construct and install the work herein i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: i i JOB ADDRESS/LOCATION ... w t ... . CENSUS TRACT Owner's 'Nam ;r-S'.: .moi ' - -.... e --- ... -. ,�;nt�f��:i.J.c_��.D.....,��`'s�c��:.rr4 ��-� ... � .,�n . ..... ..... . ............... Phone a I Address Contractor's Nome ..._ .... ...� :... f�€~ ..:.._.: . . :4. ._. ;_ ................. ....................... rla _. :. ......... •-• License * , ... Phone ... :6�. .:f.._ Installation will serve: Residence ❑Apartment Ouse ommerclol ❑Trailer Court 0 Motel [f Ofiher ... Number of living units._ _ ? %" {�-_t ? ............ Number of bedrooms -...........Garbage Grinder ............ Lot Size Water Supply: Public System and riame ..............................................._. .:............................................Private ❑ Character of soil to a depth of 3 feet: Sand b Silt❑ Clay [] Peot 0 Sandy Loam p Clay Loam ❑ Hardpan ❑ Adobe.0 Fill Material ....--_ _. If yes,type ..................... k (PlatEdri, 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 -__...• ....... ......... . ............ Liquid Depth ••-•--------•-••-•---,....Capacity - Type -------------•------ Material.-_ No. Compartments-�-•---=' - �--Dista • ...:. nce yto nearestWell •--•----....•-•---........_ ...Foundation -"• " Prop. Line ..•._•.•_•.•.-.•.- ......._.. v' . ._.LEACHING LINE . _No. of Lines .................... ... Length of each line.__..._.__.......:.. ....... Total LentM 6 g ................. i D' Box ------..._.. Type Filter Material ............:.......Depth Filter Material . . _. ._.. .... . Distance to nearest: Well ::......:............... Foundation. ........ _.,......._..... Property Line _ .. ... ._ SEEPAGE.PIT { J Depth ... Diameter ._ Number . Rock Filled Yes ❑ No ❑ Water Table Depth`-..-..,.- ......... •---- •---•-__----...Rock Size ..................... Distance to nearest: Well f , antation Permit# ...........................:.......... Foundation ..... Pro Line REPAIR/ADDITION Prev. Si ( ------- Date .....---70-0. �: F :. -... 1 _ ....i. — ..................._Disposal Field (Specify Requirements) ........ ............. e� ..�v � �ri ��- , --- "' , •ems� -_. _...��.nl. .. .... ,s--- ti r (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. Nome owner or licen- sed agents signature ceitlfies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --•-I--•-- ... Owners By .._.._- .......... �J f .. .......I...... Title ..lac :. n............. (If of er than owner) ' DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY..--. . ..... . BUILDING' PERMIT ISSUED ............. . ....... ...... DATE COMMENTS ""' ••-- .._ ' ADDITIONAL ..... - ---- _.. ... .... .. .....----•--.DATE _ -- .. .. .............. •----- ... ,� Final Inspection by -•-•--.......-•---- ......_.. .._. D. -• ... .... •............................................. ate - . ......... - SAN J AQL11N -LOCAL HEALTH DISTRICT; E. H.13 24 i.'68 Rev. SM _ _ _