71-738 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ------------------- - 7�- (Complete in Triplicate) This Permit Expires 1 Year From Date Issued 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 t - - - o_P-pQ<i`f3pahq 5-----�-- .._CENSUS TRACT ---------------•-- ------- ._-__.� _��_�_.___ ---- Owner's Name ....yJ-e,--i--J---------m©f----117qn-ju�___>--------------------- ------------------------------ ---Phone 41_ 8111,pl-- Address7 f -----------------------------------=------------------ ---------- city ----------------------------------•------ Contractor's Name -016.4—N56- - e-I- lt>�-----= "'�-Y�J ----.License # - 1 �- _ Phone Installation will serve: Residence VApartment House❑ Commercial ❑Trailer Court i❑ 4 Motel ❑Other I----------- ------------------------------- Number ------------------------ ---- Number of living units:_________ Number of bedrooms -...Garbage Grinder Lot Size ----- -_--------- Water Supply: Public System and name _*__-----___________-- : + - Private Z ---•-------------------------------------------------------------•---------- Character of soil to a depth of 3 feet: Sand'[:] Silt Clay ❑ Peat❑ Sandy Loam ❑ Gay 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,) p� PACKAGE TREATMENT [ ] SEPTIC //TTANK'[j9� Size----- >�-' ___ _ __ ___ _____ Liquid Depth .------ --____.____- N Capacity -_l.Yd 40---- Type --- -------- Material -No. Compartments ------- Distance to nearest: Well ----------40---------------Foundation ----�_----------__ Prop. Line -----/-------- Length of each line-----��_V-.�--- Total Length ---/�--1 LEACHING LINE � No. of Lines --- --•---•---- 'D' Box ----0---_ Type Filter Material _.__ ...........Depth Filter Material -------------- Distance ------------Distance to nearest: Well ----- ---- Foundation ----- ------ Property Line ----- ......... SEEPAGE PIT [ Depth __-_- � -__ Diameter ____- Number _____.l------------- Rock Filled Yes No .0 Water Table Depth ---------- ------------(-------Rock Size ------- _------------------ Distance to nearest: Well --- __ _________________Foundation Prop. Line -----t,J-----........ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------- ----------------------- Date _____-_______-__________--._------) SepticTank (Specify Requirements) -------- --- ------------------------------------------------------------------------------------------------•----------------------------- Disposal Field (Specify Requirements) -------------------------- ---------- u ---------------------------------------- ------- -------------------------------------------=----------------------------------------------------------------------------- -------------- (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 Mules and Regulations of the San Joaquin Local Health District. Flame 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 laws of California.' Signed - Owner ByL- - ------------------- Title --._ _f'' - ------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ----------------------------------------------------------------------------- DATE ----&_"-10-_`-11------------------ BUILDINGPERMIT ISSUED _ ------------ ----------------------------------------------------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------- ---------------------------------------------------------------------- -------- _-a 1-- ----- cs -------- ----------------------------- --- ---------------- -------------- -- -------- --------- ----------------------- ---------- ---------------- - Final Inspection by: _____ ________ _ Date --0.7------------------------------------ Final 1 _ -------------------------------------------------------------- ------------- --------- - - -----•-•----------------------------------- --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M L%