72-634 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: r APPLICATION FOR SANITATION PERMIT -----------=� -------- -------- Permit No. _72.-A5__ �/ y (Complete in Triplicate) r_. ---------- -------- - --------------------------------------------------------- This Permit Expires ] Year From Date Issued Date Issued Application is hereby made tothe San oaquin Local Health District for a permit to construct and install the work herein described. This application is Me in c mpliance with County Ordinance No. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION _ ------ _ 0-9Z--------------------------------- - - ------CENSUS TRACT ----------------- ----•--- Owner's Name �c s _/Ze�_/ --------------------------------------------------------------------------- ------------Phone o�&_ Address _.r26'_ /----------IV ---------------------------------------------------------- City ------------------------------------ Contractor's Name --/ �1p�,1/ ' / '�/� -------------------License #102V_` ------- Phone W- "5_2L6... r, Installation will serve: Residence Apartment House,E] Commercial ❑Trailer Court !,❑ Motel ❑ Other -- -- -------------------------------------- r Number of living units:__ _._____- Number of bedrooms ---Garbage Grinder _/ ®_- Lot Size _______________--___ 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 ❑ 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: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 0 PACKAGE TREATMENT- { 7 SEPTIC TANK'[ ] Size___________________------------------------------------------- ------- Liquid Depth ._________._____________ Capacity ----------- -------- Type -------------------- Material No. Compartments ---------------------- f . Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------_---------- � kk _,LEs CHING LINE [ ] No. of Lines ________________________ Length of each line----------------------------- Total Length `D' Box ------------ Type Filter Material---------------------Depth Filter Material --------------------------- Distance to nearest: Well ________________________ Foundation ------------------------ Property Line ---_---•-•---__---_--•_- ..r SEEPAGE AIT [ ) Depth Diameter ---------------- Number - Rock Filled Yes ❑ No Water Table Depth ------------------------------------------------Rock Size -------------------------------- r r' Distance to.nearest: Well ---------------------------------- ----Foundation -------------------- Prop. Line ----------__.....__-_. ! "REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----------_-------•-----.----_---) Septic 76nk (Specify Requirements) ---------------------------------------------------------------------------------------------------- ------..__... .Disposal Field (Specify Requirements) ------ ------1___A---- ---------------- -------------- ----------------------------------- r.: ---------------- x'FY (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 ageitf''signature certifies the following: "I certify th'af 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 o Workman's Compensation laws of California." Signed %. _�r . .- . - ---- -Po ----------------------------------------------- Owner B Y ti= ----------------- - ------------------- Title ------------------w. If the th FOR ARTMENT USE ONLY APPLICATION ACCEPTED 'tY ______ _ DATE BUILDING, PERMIT'.ISSUED DATE-------- --- ---------------- DITIONAL COMM N -------- --�-`--1-------Y------ --'---- --------- ----- ----------------------------------------- -- - - - --------------------- = �- `---=- . --------------------------------------------------- Final Ins - --------- --Y ,' ;: - --- -------------------------------------------------------- -------Date ------- } r ! o-'� SACS JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 -'68 Rev. 5M