73-287 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ................ ................................ Permit No. ..7.3_: 7.... (Complete in Triplicate) _....................... x 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 .`�L. ,; _,..:: !f,...._.. !.`. ... c>(.................CENSUS TRACT !.Yl.....--......_. I Owner's Name .............0..I c, _ ..Yi.2.. G a ...Phone Address- ==Z �` � .. ... ........ `� �'.- ft a "-`r".`-��--- City --------- ---- =D..0 --- • .................... .................... c, Contractor's Name ..�` .rC. rir .,S_..._` - --�-=~ "K..License # .. .bq .l.. Phone .y�o ... �!f .._ . 4 tAl Installation will serve: Residence Apartment� Hot�se'S Commercial Trailer Court 0l i Motel ❑:Othdr ---------.................._................ _ Number of living units:..... Number of,bedrooms ----9.---Garbage Grinder _._ -------- Lot Size ..ajz..._.X... ......... Water4Supply: Public System and name .................. l . Private Character of soil to a depth of 3 feet: , Sand Silt❑ Clay�'t] Peat❑ Sandy Loam ❑ Clay Loam ❑ �-,,HardpanjM .Adobe ❑ F41 Material .----------- If yes, type ............................ (Plot plan, showing size of lot, location of system in relation.to wells, buildings, etc. must be. placed onreverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTI(STANK --Size f ;� 1M_ . '_ -X � Liquid Depth �j F ccapacity-•-AgWe-GAJ Type -eq ........... Materialr-&. ... No. Compartments ... .......•. � + U v j I7 stdnee-tv-=`n-cirest. Well ...--__..�_.lt__ ..............Foundation ... ....... Prop. Line ... LEACHING LINE [X N of;Lines ___._._..�__.______ Length of each line.______._ U._....... Total length -_.-_�9a -.__.._.. a a D' Box Type Material aY........Depth Filter Material ---------------------------------------- Distance to nearest: Well ........ Foundation ........ Property Line _..., �I..__.....--. SEEPAGE PIT [x} Depth ------- Diameter _. Number ._.-------,` ...... Rock Filled Yes j4 No ❑ , i {"i i. • Water Table Depth ,� ....._ :Rock Size ............. Distance to+nearest: Well ........ /Oj!7 . _....__•._._...Foundation ..,f!d...� .Prop. line .. ele50............ REPAIR/ADDITION(Prev. Sanitation Permit# ................................-------------•-........... Date ..............'^.................} Septic Tank (Specify Requirements) -------- Disposal Field ISpecify Requirement --'---_ f + �.7 . fA ............. ! ._.-.____�__�__________________ ._________.-___-__-_.----_-.__---_-______---_---..____._-._ } (Draw existing and required addition on reverse side) 1 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 Son 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, I shall not employ any person in such manner as to become subjetrta W6rkmdn's-Compensatibn'laws of-California." Signed ---------------------------------------------..................................----••...... Owner BY ---------- C � _... .Title ---- ...... -----••-- --- (If other than owner) FOR DEPARTMENT USE ONLY 77 APPLICATION ACCEPTED BY... ....-------•..................•-•--•... = .---•---- -'j — DATE .... .... -----J------- BUILDING PERMIT ISSUED DATE ADDITIONALCOMMENTS ................................................................... ............. ...........1::......._........:.............:............_._.. --------------------------------------------.---------------------------------------- ------------------•........................._.............. Final I . '--...----- ••-..__. _ ...............•--.... ••----•-------•-------i. ._...--_tom. _.-- Y `.. ..•• .. ..... arispection by: .. ............. .. :. r _.....---•-•-•-•---•----....._. ........ Date � ..7 ------------------ SAN --SAN JOAQUIN LOCAL HEALTH DISTRICT _ F w 13 24 1_-Aa D.. s �•: 7/79 3 H