73-46 - Laserfiche WebLink

Home Browse Search

FOR OFFICE--USE: ° APPLICATION FOR SANITATION PERMIT ------------------------------------- (Complete in Triplicate) Permit No. --------------------------------------- This Permit Expires ] 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: i JOB ADDRESS/LOCATION _----^3i -�% -j__-_- ra_--1c3_c ner's Name _ _ ` 1--------------------------- CENSUS TRACT RACT Ow _ 4- ��------- ' --- ---T--- - ---LI e _ ' . . _ .__ JP; hone _. --- aCl -----. city----- a . �► -------------- Contractor's Nam ' M f{ s ----- - ---- - ---- - Phone Installation will serve: Residence [A'Apartment House^❑ Commercial :❑Trailer Court ;❑ _ Mote! ❑Other------------- NurribW'of living units: ___ --_ . Number of bedrooms __13Lot Sizea Grinder_____Garbo9 -_ _- . d` f�� r' a _ -------------------------- Water Supply: Public System and name ________________________ __ _ __________Private, , Character of soil to a depth of 3 feet: Sand';---.'Adobe Clay ❑ Peat E] Sandy Loam ❑ Clay Loam --- ',.-Hardpan [] Fill Material __-i/V=_ If yes, type ---------- ---------------- -_ (Plot plan, showing size of lot, location of system in ation to wells, buildings, etc. must be placed on reverse side.) ' NEW INSTALLATION: (No septic tank or seepa pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK. Size.---IS-, c�4?4-1----------- Liquid Depth --_ , �___-___._____ Capacity fi �� Type --------------- Materia 11f e_ N _jW]G,No. Compartments Distance to nearest: Well ----. Q ------------- --- _457_1---------- Prop:Line ----------------------- LEACHING LEACHING LINEc [ ] No. of Lines -------- _--_---------- Length of each line------�� __.____._ Total Length 'D' Box ---- Type Filter Material SAHC:(----Depth Filter Material ----90Ft . .. _ Distance to nearest: Well -----'50,---- ____ Foundation --___. _-__ - Prope`rty Line �_-5� SEEPAGE PIT [ ] Depth _. _ Di meter 4y,--g------ Number ------------ ---------- Rock Filled Yes � No i❑ Water Table Depth _ - ----------- ------Rock Size ------------------------- Distance ----- ------•Distance to nearest: Well -------V C?o-- -------------------Foundation ----------- ----- Prop. Line --------------------_ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date Septic Tank (Specify Requirements) -- ---------f-_=_, L, S-C? C -_-__f�.� rDisposal Field (Specify Requirements) ------ ---------------------- - -- -- - rtf. - "` ---------------------------------------------------.- ----- -------- -----------------------_------------------- (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 rk for which this permit is issued, I shall not employ any person in such manner as to become subjecp to Workman's Co sation laws of California." Signed ------ ----- - ----- - --- -- -- ------ -------------.--. Owner BYll r _- � Title ------ (� (If other than owner! FOR DEPARTMENT USE ONLY �� APPLICATION ACCEPTED BY ! - --------- ---------------------------------------------------------- --- DATE -- BUILDING PERMIT ISSUED ----- ----------_-DATE --- � ---------------------------------------------------=---------- ADDITIONAL COMMENTS ----- --------------------- ------ -------- -------------------- 1 Fina! Inspec - --- -------------------------------------------Date ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H- 9 1-'68 Rev. 5M �; -