72-272 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------- Permit No. (Complete in Triplicate) ---------- 4 Date Issued --- �L --------------------- ------------------- --------------- This Permit Expires f Year From Date Issued Application is hereby made to the San Joaquin Local Health Distriq 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/LOC N ._._../___ /l. ----A_ ......A,.V-;Z_Z---------------CENSUS TRACT -------------------------- Owner's Name ___W,17-1----------- '-- -----•----------------------------- ------- -'-----------Phone a Address ------ / 7/l_5a�.--------)? ?-,5------------- -------------1 Cit -------------------------------------------------- ------ Contractor's Name -..-_____ -____�M--� -�1__ -------------License # 7�_.7_�-`Il-__ Phone _ )- _ Installation will serve: Residence ❑Apartment House❑ Commercial g]Trailer Court r',❑ Motel ❑ Other ------------ '------------ ----------------- Number of living unitsA/0NG_ Number of bedrooms wdj!1 :)__Garbage Grinder 1✓d------ Lot Size -____�----- A n Water Supply: Public System and name _-__ ______- ______G� __Private Character of soil to a depth of 3 feet: i Sand'0 Sift❑ Gay ❑ Peat ❑ Sandy Loam -❑ Clay Loam Hardpan ❑ Adobe 0 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,) I<SEPTIC o 1►. PACKAGE TREATMENT [ ] SEPTICTANK [k Size--__.� _____ ---- Liquid Depth ____+ _ _ ____________ � Material---i! ---- -- No. Compartments —------....... Ca acityA2_o c_-6WType �t Distance to nearest: Weil ----_�G____------------------Foundation ---/ff__-_________ Prop. line ._. --- LEACHING LINE Yq No, of Lines ------- -------------- Length 'of each line______ Total Length ____ ----------- . �� D' Box �4.___ Type Filter Material,_, , ------Depth Filter Material __,._�,-___--------___________________ T _____ Foundation _.__--A5?_`____`___ Property Line w r Distance to nearest: Well __ �/_'_.� ) � p ---�------------------ SEEPAGE PIT Depth J54 -------- Diameter _ -`_-__ Number ------/-________---------- Rock Filled Yes [.�C No Water Table Depth --------- -- -------------------------------Rock Size ----- - ---------•- Distance to nearest: Well ------ _G*:''_____-------------Foundation v--- d--_------- Prop.'Line ___�~.r......... REPAIR/ADDITION(Prev. Sanitation Permit# --------__________________+----------- ---- Date '`------_____.___________-----____) Septic Tank (Specify Requirements) -------- - -- 4 -�=- -�`-a---------—----- .�.-�"�C -- �- Disposal Field (Specify Requirements) ----- - --- -----------_---------- ----------- C----------------------- ---------------------------------------------------------------------------------------------------------------------------------------------•-----------------------------------_----------•------------- v =-------------------------------- -•------- - --------- --------- ------- ---- -----------------_.�_.----------------------- ----------- _ -- ------ (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: "1 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 --------- ---- --------- ------ �_. '�`"'z��. r � ------------ Title f— By -------------------- ----------- `-- -c --- = ---------- ----------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------------------- DATE 2731-,7------- -- --------- BUILDING PERMIT ISSUED ------------------------------------------------------------------- ------------------------------DATE ---- -------------------------------------- ADDITIONAL ---------------------- ------ ADDITIONAL COMMENTS --- --- ------------------------------------------------- ----- - - - ------ - - -- ----------- ---- - _;;0 cz ,� �. -_e --— -r�-�'---------------__---------------------------_----------------.--- ------------------ ___ f. W--------- -- r --------------------------- ----- --------------------------------- ---- ----- -- e --- - -------- -- ---- Final Inspection by: 1 ------------------------------- ---------------------------------------------Date '• V � ��-- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 7-'68 Rev. 5M