72-208 - Laserfiche WebLink

Home Browse Search

r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: -------------- r3?`--- --- ------------•-------------- ----- (Complete in Triplicate) 4 - r � Date Issued _•.'�. "'"_7._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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._ - - ---- '-- - __ad_ -(.5------------ ------------------CENSUS TRACT -------- Phone _-- - -- Owner's Nam e s!5� h-L ---------P_-------srr�/'EuS -----------------------=- ----------/------- �,�7�y"--- ---------------------• cit �!�!/l��.i l-- ------- ----------------------------------- ------- Address --------=--------- d/h ------------------- Y Contractor's Name -------- -----S-A-w-6-----------------------------------------------------------License # f777777=--------- Phone --------------------------_-- Installation will serve. ResidenceApartment House❑ Commercial :❑Trailer Court 0 Motel ❑Other -------------------------------------------- Number of living units:__-_1____._ Number of bedrooms �;_____Garba_ge Grinder _.- Lot Size ""-/�---__ G✓' _____ Y ---------------------------------------------- Character - at Sand Loam Private Water Supply..] Public System and name _ _ __ _ _ __ _"""____________ ____._______ - -------------------------------------------- I Character of soil to a depth of 3 feet. Sand Jg Silt❑ Clay ❑ Pe ❑ y ❑ Clay Loam `l 4 4 � Hardpan Adobe Fill Material -------- -- If yes,type "____.________'____--------\\\ i (Plot plan, showing size of lot, location of sysfem 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 av a it n 200 feet,] PACKAGE TREATMENT [ SEPTIC TANK 11ow. -'--- � J quid Depth --- —----,----- Caacit l�Type�-��ateriai_C-CX1 a. Compartments __ --.--.------ i? =-. V Distance to nearest: Well ----------------_-----------,--------Foundation ------------ --------- Prop. Line ---------- LEACHING LINE [ ] No. of Lines -------------- ________ Length of each line—-------------------------- Total Length ______________-.... O D' Box ------ ----- Type Filter Materlal ____________________Depth Filter Material ---"__________________"-----------------•- �, Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ------------------------ %Q SEEPAGE PIT [ ] Depth --------- ---- ----- Diameter ---------------- Number -------------_------------ Rock Filled Yes ❑ No ❑ IN IWater Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well -----------------------------------------Foundation --------------- ---- Prop. Line ________________ REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------- --------------- Date ______-___._____------------------] Septic Tank (Specify Requirements] ----- -- .--------- r� ---- -`�/- r f - -- - I D' osal Field {Specify Requi mems] ----! •--- ------------- - ,, _ t �.: - r" -------- -------_� _. __3 _ -- f (DraZexistin nd required addition on reverse side) " 1 hereby certify that I have prepared this application and that the work will be f Ibne in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifiesfthajollovring: `"I certify that in the performAceof the work for which this permit is issued, II shall not employ any person in such manner as to become subject to W�kman's pensation laws of California." � - Signed _ �c-cs kt-�---iJ----------------- µ ----- Owner Title ------- (If other than owner) ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- ----"----- /J DATE -- ----- - f__ -- BUILDINGPERMIT ISSUED ---------------------------------------- 1� - ----------DATE -----------------------------------------•- ADDITIONAL COMMENTS - -- ! K J ------------------------------------------ - ------------------------------------------------ ------ ----------- --- -- ---------- ,� r �_ , ------------------------ ----- - Final Inspection by ` Date ---- r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M