73-537 - Laserfiche WebLink

Home Browse Search

FOR OFFICE 415E;h APPLICATION-FOR SANITATION PERMIT -...................I.. . . ....:...........�_:.'�° Permit No. ..?:3�_ ..3. I� (Complete in Triplicate) k ` Date Issued —73 -„-,.-,•.,,-.---„,,„ ,,,,,,,,;, .I......,__-.••• 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 compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION ..... .............................CENSUS TRACT ................ Owner's Name . ....... %e. - -..Cf ..._ Phone ...................... Address )11«� I—............... _.._._.---...._.� ..�� ..._..-- — ------------------- - ----. city '<` ' --............._..__ Contractor's Name,-- - - License # z�.,��.�pJ.-. Phone . ..�..._..,�.._..... Installation will serve`: Residence "Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ...... Number of living units:......... Number of b Brooms .._��1------Garboe. Grinder Lot Size _� _� �/.......... Water Supply. PublieSystem and name . _ �� '4"f` _-�i'� -...�-----.........................................:-....._...Private ❑ `. Character of soil to alldepth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ............ If yes,type ..........--------------...:. (Plot plan, showing 1�size '-of lot, location of system. in relation to wells, buildings,,etc: must be placed on reverse sid 'I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,J PACKAGE TREATMENT [ ] SEPTIC TANK Size. Depth ....... Capacity/nGv Type K-Moteriol. � =o. ...... W Compartments --_."G�.............. } Distance to nearest: Welllc.--_ f-----.._Foundation Prop. line ....11� .......... LEACHING LINE No. of Lines _ w r ` - -.. -. .. Length of each Eine,....__.-�.�._..._.... Total length =��V------------- ( I D' Box , Type Filter Material Depth Filter Materia) ...�,�...........:........•-:----•--:- Distance to nearest: Well ,= 1_L Foundation ........... Property Line _s16..............:... e SEEPAGE PIT ” Depth ,�5- �.. Diameter _ '_` Number _.... __....._._.....___ Rock Filled Yes No C] s Water Table Depth -------•-- -- ------------------------Rock Size ---•-•----..__....__-- t Distance to nearest. Well ._, 1-;:.- i!i -...._.;:::Foundation,-X,'' ........... Prop. Line . �^_f_..... REPAIR/ADDITIONEPrev. Sanitation Permit -------,_-................. :--- -- ---- Date ..................................) 4 Septic Tank (Specify Requirements) -- ............... .................. 11 Disposal Field (Specify Requirements) .... -- ... . . .. .... ........___....................__ ---------- ----------- �� ........... .. ... . '- . ........................... ---------•----- . . .-_......_...--- ._......•.......--'---......---- - -- -.....•---......._...._ ------- --- - ... ................ ...... .......... ------ --------------I............. --..- i (Draw existing and required addition on reverse side) I hereby certify that 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,�certifies 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 Owner - 4,�W--� if th Title By �CC��Lf Wit'-- _.� ./�._.._... ._..:- ._ . ( o I`r than owner) II FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .._. .� 1�__._.�. Y ..._.•. DATE BUILDING PERMIT ISSUED .... --- -- . '--- ------ ... ....:.........:...DATE . .._..............._....... ......_. ADDITIONALCOMMENTS ............. --------_---------------- ------- ..................-..•...-. .... -...............................1................. .....----•.. ...... .....•----i1...._......_............. ---.........__...._..._....--•- •----- _....... - .............---"---._..............--- ------. -----•..........---- -'----•-•------- ................................................ .............................................................:.....•...................----._- ..-.--......__. ..._._-- `i q a .----------•....................Alk . . . . ------ - Final Inspection by: ---------•-- ••-•-- -•--- .....:..Date ....... ......7 ? ....... :.:.... F SAN::JOAQUIN -LocAt HEALTH DISTRICT t, 3 MF. H. 24 t- 68 Rev. 5M - - -- 7/72