73-619 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 737-4- ----------- ---------------------------------- (Complete in Triplicate) Permit No: _______________ 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 . �_Win`' � , ., ►t• ---------------- --CENSUS TRACT ----------- Owner's Name _141-711-7--------- ------- -2-�--Z----- -------Phone �� 3 -(--------.- ��-----------�D_/ _ 'l p'. City Address -- --- - ---- - ----- --------------------•-------------------•---•-• Contractor's Name •'a,-`�------------------------------------------- License # ---------:-------------- Phone ------------------------------ Installation will serve: Residence-fil Apartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other -------------------------------------------- Number of living units:--/-------- Number of bedrooms ___ ----- Grinder _/_.�,-_-- Lot Size --___________-__.--__- Water Supply: Public System and name ------------------------------ ----------------------------------------------------•-----•---------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay 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,) PACKAGE TREATMENT { ] SEPTIC TANK;] Size____ ___________________________________________ Liquid Depth __________--___-____--_- Capacity/&000------.- Type)Z;4N_;,gA4—_ Material -------------------- No. Compartments ----•---._ ......... Distance to nearest: Well _��_`__________________________Foundation _,�4�__________.._ Prop. Line jC._.__:__._.___� LEACHING LINE D4 No. of Lines -_-�------------------ Length of each line____'4/4'_______...._.__ Total Length 142__0_------.--------d 'D' Box er u-_._ Type Filter Material 117-°---------Depth Filter Material __/ _:"_______________________________z Distance sto nearest: Well ___4d'_____________ Foundation _l4?---------------- Property Line____. SEEPAGE PIT Depth _sA-.57.___ ___ Diameter _3_ -------- Number ___ _____________________ Rock Filled Yes,8' No .i❑ L V ' Water Table Depth C -------------------------------Rock Size - -V-' ---------------_-- �+ Distance to nearest: Well /0�_+_________________________Foundation __ B_.......... Prop. Line __.._:------ -± REPAIR/ADDITION{Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------------------------------------fy DisposalField (Specify Requirements) ---------------------------•--•--------------------------------------------- --------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- -------------•---------- --------------------.---------------- ----------------------- -----------_-------------------------------- - ------------------------------------------------------------------------------------------ (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. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the w for which this permit is issued, II shall not employ any person in such manner as to bec 'ect to Workman' sation laws of California." Signe6-�j -- --------- - Owner By - ------------------------------------ ------- Title -- --------------------- - ------------------------------------ --------------------- --------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------------------------------DATE .- _�, 3 ----------------------- ----------------------- BUILDINGPERMIT ISSUED ----------------------------------------------------------------- ------------------;----------- DATE ------- ----------------------------------- ADDITIONAL COMMENTS ------------------ ---- ------------------------------------------ - - ` _ ------------------- - - fI "Z � - � _ � ---------------------------------- ---------------------------------------- Final Inspection b .-� pate �s� ------- - ------ - -- - - - -- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M