73-411 - Laserfiche WebLink

Home Browse Search

" FbR OFFICE USE: APPLICATION FOR SANITATION PERMIT ....................I..................... Permit No. .73—� (Complete in Triplicate) ........""' This Permit Expires 1 Year From bate Issued Date issued S1 � 73 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, 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ,... ..`� �....... .'`.( ��.............................CENSUS TRACT .............. Owner's Name .............. . eu"ew..-- ... .......... hone ..4a ........ ....... .� .!ryy ..�f.Fl.T.... . . ..�..v...... . Address ..........s 5... ._... ... ..... ' •' ...."........ City - �..... ::..........._......... ...... ..... Contractor's Name ...... .... ..license # AkY 1.".f.. Phone . j Installation will serve: Residence 'Apartment House Commercial ❑Trailer Court 0 Motel ❑Other ............................................ Number of living units:...../.. Number of bedrooms Garbage Ander 7 Lot Size Water Supply: Public System and name ...., . . lk Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom Ail Hardpan ❑ Adob 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,) f nn Size. X ..... Liquid Depthth ... ..............PACKAGE TREATMENT SEPTIC TANK ' Capacity Type Material._ �I4 No. Compartments .. .............. r Distance to nearest: Well .....S ......................Foundation'../O............. Prop. Line ,I......... LEACHING LINE of No. of Lines ....A2............... Length of each line...f..6 v..'.......... Total Length ...c Y. 'c?.......... 'D' Box ../.... Type Filter Material ....Depth Filter Material ... .`...`........ Distance to nearest: Well .... . 4..,..._.. ....... Foundation .tea ............ Property Line ................... SEEPAGE PIT Depth 5 `..._._ Diameter 11.1..,x.. Number .....off,.................. Rock Filled Yes ,( No Water Table Depth rlj0" ..................stock Size ..e ................. Distance to nearest: Well hl.fr.'.. Foundation .................... Prop. Line S� REPAIR/ADDITION(Prev. Sanitation Permit SIE ............................................ Date ..................................) SepticTank (Specify Requirements) ................._. ........... ............................................................................................................ Disposal Field (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 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 By r ............................. ... ... Owner. -1 ,p . Title ..... (If other than owner) FOR DEPARTMENT USE ONLY • APPLICATION ACCEPTED BY . .. ............................. ............................... DATE . .:.`. ....1�.�............ . . . BUILDING PERMIT ISSUED ....I................ ...................:.............................•---•--------•-••----.-------.......DATE ...........................---------....... ADDITIONALCOMMENTS ......................................................................................•••-------................... .................................................................................•--................................:_..........---•--....---------•--......----......... .,. •---..................------ Final Inspection by: ..... .. ....................................I..........................----Date . ...l f ............. SAN JOAQUIN LOCAL HEALTH DISTRICT L3 24 .--,..... �..,, a E. H. 1-'b8 Rev:`3N1 � 7/72 3 M -- ---�