73-937 - Laserfiche WebLink

Home Browse Search

' _ f ,. it�,�. -.�_•- _. r - �- FOR OFFICE USE. .il •- i - ., -.. ___ - ._ , j APPLICATION FOR SANITATION PERMIT ........I....... . ......................i (Complete in Triplicate) Permit No. This Permit Expires 1 Year From Date issued -. :,15ate � Application is herebyq1 made to the San Joa uin"Local Health District fora permit to construct and install the work herein described. This application is made in compliance with-County Orcfinance'No.�549•'and existing Rules and Regula ; V JOB ADDRESS/LOCATIO rt ons: Owner's Name64 CENSUS TRACT __.....---•••. Address ..._...o .,�`" \ Pho..................... ne .... Contractor's Name City . /�._...._...._..._. e� ........... Installation will serve: -•-•`..••••.... ---------•••__.License # �f/a0�� Phone Residence 0 Apartment House 0 Commercial []Trailer Court ❑ �� Motel 0 Other;€_..... Number of living units:.._ ----- Numberof bedrooms ._.��.-. Water Supply: Public System and name Garbage Grinder .!"� -- Lot Size Character of soil to a depth of 3 feet: Sand❑ .Private 0 ..Silt❑ Clay ❑ Pe" ❑ Sandy Loam ............... Hard an 0 Clay Loam 0 P ❑ Adobe ' Fili Material ._..._..-.._ If yes. type ------- ............ (Plot plan, showing size'Of 10t,--location-of..-,system-'in 'relation--to'wells;-buildin s etc. • NEW INSTALLATION- {No septic tank or seepage g � must be placed on reverse side.} PACKAGE TREATMENT pit permitted if public sewrer`is available within 200.feet [ ] SEPTIC TANK''[ ] ¢ 1� Size.. CapacCa Liquid Depth , ity ---� p y ...............•---• Type --------------- Material---- Distance No. Compartments ..---.:--- Distance to nearest: Well .._. � i ••••--••--- � t -------- ------•---•••-•-•-•---Foundation ..• Prap. Line ._......__.. LEACHING LINT: [ ) No, of Lines - � ---••------ Length of each line...------ ' ....... Total Tota! - 'length -- Type Filter Material �D' Box .._....._ Depth Filter -•-- Distance to nearest.'Well -------------- Material ...._...._:_._.-•------•--- SEEPAGE Piz ` Foundation ...............:....••.- Property'Line . Diameter 0` s -.....-._• I -.—�� ) Depth ..........:..... .. ................ Number --•----••.-----._.. ` --_._ .. Rock Fill Yes ❑. No Water Table De pth ............................. Distance to nearest. Well Size _- I ..........................----••--•--•-----•• tion . Prap REPAIR/ADDITION(Prev.'Sanitation P • Line Permit 4 - Septic Tank (Specify ' --• Date ( p Requirements) -•--''-•j # • Yq } .................... ----. ..._. .......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 Local Health District. Home owner or County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Ll licen- sed agents signature certifies the following: q 'Al certify that in the performance of the work for which this permit is issued, I shall not employ an as to become subject to Workman's Compensation laws of California." p y Y person in such manner Signed .............•- -. _.._- - ' y .............. Owner .. Title {lf # er.t41 han owner) --••................. ' y - f OR Ia TMENT�LlSE 'LY APPLICATION ACCEPTED a ; BUILDING PERMIT ISSUED ....._. � -------- - •• -"•...... - ADDITIONAL COMMENTS --...-_:}.......---•- = =---•-...•............. DATE [_.........DATE ! ...................... ... --••--- --- ........-i........ ••--------- ......... -•---•--•---•-----•-------- ---.._..'_.....-•-•--.........._..._...--.•-•- - ------•----•------------------------- Final Inspection by: . .--•-••-•-....._..•._ *-°-----•--...-•---•-------•-•.............. .......... _._..... .._..._... ' F . r• ..'.. Date...1..........:7.11 ._ . ...........i . ..__... SAN.JOAQUIN ,LOCAL HEALTH DISTRICT -'b8 Rev 5M d