73-884 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --------------------- (Complete in Triplicate) 6N_7 � ------------------ ---------- --- Date Issued L'o7�7 - - -------------- This Permit Expires 1 Year From 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 co fiance with Count Ordinance No. 549 and existing Rules and Regulations: �'�`' �X � PX_._W�-�••-`-`�CENSUS TRACT --------------•--•-------- JOB ADDRESS/ A ON ----R o� t ------------ ------Phone Owner's Name ly------------ -- -- -- -- -------------------- --- - ... t Address ------------ -- ----��f rn � __ - = City Contractor's Name -- -_� f ' ) --------License # ff3_�y Phone ------------------------------ � Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court :[I Motel ❑Other Number of living units_--]------ Number of bedrooms .2-----Garbage Grinder ------------ Lot Size -----._-_---__----------- Private,` Water Supply: Public System and name ___________________________-_ y Character of soil to a depth of 3 feet, Sand'[] Silt 0 Clay ® Peat E] aSandy Loam ❑ Cla 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,) !/ --- Liquid Depth -- `------------------ PACKAGE TREATMENT [ ] SEPTIC TANK:[� Size___ __ _�_-�_�--_�-✓-_ --- _-- Material--- ------- -- o. Compartments ---- '.- L t Capacity �' Type oG1 +y ---- f- J ------ Prop. --- Disfiance to nearest. Well ____ Y---f ---------Foundation € f Tofial Len ---- 9 { / No. of Lines 9 LEACHING LINE [ __----f------- ---- Length of each line--------/-�0-� Length __-- -------- l't " } 'D' Box _r___ Type Filter Material ___�_5_,P1-.----.Depth Filter Ma#erial _________ _ ___ __ i Distance to near st: Well _ _/� Foundation ___._.---__=j_b__ --- Property Eine __ _______________ f SEEPAGE PIT [� Depth _ fix- - Diameter -1-3------. Number.__-._._ Rock Filled Yes No ' -- ' Water Table Depth ------- btu- ----------•---Rock Size __ y.2- ,•X 3--------- ` Distance to nearest: Well ----- Foundation __--`- ---------- Prop. Line ..___ -..--------- (O REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------------- ,,Septic Tank (Specify Requirements) -- ------------------------------------------------------------------------------------ -------- �y Disposal Field (Specify Requirements) -------------- ---------- ---------- ------------ ------------ ----------- ----------- �1 --------- --------------------------------------------------------------------------------------------------------------------------------------------------------- (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. Horne 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 laylls f California." f Signed _�------ ------------- --------- - Owner - - ---- ------- ------ By Title -------------- ------ -- -- ------ -- ----------------- - �' (If other than owner} FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY ----- - ------------------------ ------------------ ---------------------------------. DATE BUILDING PERMIT ISSUED ---------------------- -- --------------DAT ---- -------- ----------------------------- ADDITIONALCOMMENTS ----------------- -- ------------- -------------------------------------------------------------- --------------------------- ----------------------------------------------------------------------------------I------ _ -------------------------------------------- - ------------------------------------------------------------------------------y� Final Inspection by ------- -------------------- Date 7_�. c�_._7a --- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT F E. H. 9 1-'6$ Rev. 5M