72-577 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------- ---- --------- ------------------------ Permit No: (Complete in Triplicate) ------------------ --------------------------------------- s U 7 U Date Issued :...... _:" " ""____-------"".""_.._-__-___"""" This Permit Expires ] Year From'Date Issued Application is hereby made to the S n 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. RD JOB AQQRESS/LOCATION .- D.S _ -----a------ 0 �� --------- R CENSUS TRACT, '` .�----- Owner's Name -------- - _W _ - C� ---------- - _E_" - ---------------------------------- ------Phone-: t Address -------- >c3 - J�-------------�--SS---------------------• City �-�-C� LQ '--------------------- i -- - -------- T i 1 Contractor's Name Q_Wlv_E - License # Phone f' � �.� Installation will serve: Residence �ment House❑ Commercial ❑Trailer Court .❑ i Motel ❑Other ---- --------------------------------------- ! Number of living units,' ___.:_'-Number of bedrooms ______Garbage Grinder Lot Size _. _ hi�i] _---- I Water Supply: Public System and name -------------------- 4 --------- -------------------------------------------- ---------------!---Private Character of soil to a depth of 3 feet: Sand'❑ • Clay E] Peat F] Sandy Loam ❑ Cly Loam r1� -�..].µ.ry i Hardpan Adobe El Fill Material ------------ If yes, type ----____- -__ _ _ ___ 4 (Plot .plan, showing size of�lot,�location of system in relation to- wells, buildings, etc, must be placed on reverse side.) 'V NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avails le within 200-feet,) O X11., ' q PACKAGE TREATMENT [ ] SEPTIC TANK:[ I Size___ _______________________ _-- _.-_ Liquid 'Depth' ___ r _________-___. L4 . --- . _,.- - - Ca acit - Type ------------------- Material----- ------ o. Compartrr'ents __:----.-•-------•---- Distance-to nearest: Well - ------------------------------- -Foundation ------ _ Prop:tine ----------.----------- LEACHING,LINE -No. `of Lines --------------------------------- -Length of each line------------------------- -_ Total Length,:,.+--------:_-____.- 'D' Box ------------ Type Filter ftterial --------------------Depth Filter Material ---------'--;- '----------:..-.---------•---- t t Distance to nearest: Well ___ ___________________ Foundation ------------------ ----- Property Line_ -----:__..-_-_____._.__. SEEPAGE PITT [ ] Depth ---------------- Number -----?_ :1------------ __ Rock Filled Yes No i❑ Wafter Table:Depth ------------- - -- -----Rock Size --------- - -------------------- i -Line to nearest: Well ------------------ _•_Foundationj� _ _-__-------- Prop. ---I--__ .____""__---- REPAIR A T N(Prev. Sanitation Permit _ ---1- -------------------------1 Date ------------------ Septic Tank (SpeElfy Requirements fD ---- ---•- ____________ Dis osal Field...(Specify Requirements) -------------- /C' -------------1C; JA __Y_1,1_2- ----------- 5-E-�F-PA67 --- 'ply--------------------- ------------------------------------------------------- ----- - ------------------ (Drawexisting and required addition on reverse side).._- .�tt 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 liven. sed agents signature-certifies the following: "1 certify th t in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to bec a subject to`Workman's C �fpenaws of California." Signe ' f !, •------------------- Owner `t c. '= BY - ,_ -------------------------------------------- ---------, ---------------------71-[U -- Title ----- ------------------------ - ---------------------------------- (if --- -----------'- - (If other than owner] FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- --- ---------------------------------------------------------- -----• DAT ___57 BUILDING PERMIT ISSUED �. ----- = '-` --------------•-------------- ---------DATE -------°..---- "---------------- t ADDITIONAL COMMENTS ----- - -------------------- --------- - ------ - ------------- ---- ----- -------------------------------- ----------- --- l -- ---------- ------------ ---------------- ---------------------------- ------------------------------ ------ - -- ----- - -------------------=---- --- --------------------- ------- ---------- ----- - -- -- ---------------------- ------- -- ---- `1 Final Inspection --- ------ --- ------- - - - ---- -------•---------------------- Date ---- �:.'A_ __._.17------ - - - SAN JOAQUIN LOCA, ,HEALTH DISTRICT E. H..9 1-'68 Rev. 5M