72-483 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --- - -------------•-------------- (Compfete in Triplicate) Permit No. -,71._---------- ----------- ---- --------------- ----------------------------------------- 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 --1.7Z =S------- -- ---_CENSUS TRACT ----- �n `` p _z 25 Owner's Name .l-f l�� L_/--1L_ N _ _F.Tr Phone Address ------t7rL---q!7--- - S-------F=NTERPP_ZAS!� --------------- City ----- --------------=1----------- ------------- Contractor's Name _�t/ll1vF .'-----------�-------------------------------- License # Phone '. -----...-------•-- Installation will serve: Residencei�rtment Nouse❑ Commercial ❑Trailer Court i❑ 4� �. '• Address ;tT N. jr t - _ w� O4Kcict �' ._ . City Water Supply: Public System and name ----------------------• ---------------------------------------------- -----------------Private Character of soil to a depth of 3 feet: Sand'❑ ❑ Clay ❑ Peat❑ Sandy Locim-'0., Clay Loam Hardpan Adobe ❑ Fill Material ----- ------ If yes,type ___________________________ (Plot plan, showing size of lot, location of sys m in relation to wells, buildings, etc. lust be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepa a pit permitted if public sewer is,availa le within 200 feet,) PACKAGE: TREATMENT [ ] SEPTIC TANK [ ] Size____________________________--_•__.____-- ---- Liquid Depth ________---_____________._ V Capacity -------------------- T pe -----= ---------- Material--------------------- o. Compartments ----------------_--- Distance to nearest: ell ------------------------------------Foundation ------ --------------- Prop. Line ---.---------------.-- LEACHING LINE [ ] No. of Lines _______________ ________ Length of each line____ , ____________..__- __ Total Length ---------- _------------- -------------- i _______-.-.-.._- V►� 'D' -Box--.---'------ Type ilterMaterial --------------------Depth Filter aerial"-``---------------------------------------- Distance to nearest: ell ___µ____________I_---- Foundation ---------------- ------- Property Line _-__--_.__ .__. - {z SEEPAGE PIT [ ] Depth ____________________ iameter ---------------- Number .---_-_.______--__ ------- Rock Filled Yes ❑ No ❑ � a Water Table Depth __________Rock Size ____ _ ___ -=--------- -- _-- Distance to nearest: ______________________Foundation __ __ ------------ Prop. Line __________-_---_---_-_ REPAIR/ADDITION(Prev. Sanitation Permit# -• --------------------------------------- Date --------------- ----------------} Septic Tank (Specify 'R-equiren)enta) -------- ---------------------------- Disposal Field (Specify Requirements),,---4:/sfeV7-------I-v---- --- K------t . C7-------- S' __`-- _l� .l�l� ------ � C -----------.-- T" Lf T<9------ s �' E- 1 ' X X! (Draw existing and required addition on reverse side[ I hereby certify that 1 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 s" ature certifies the following'- "I ollowing: ,f y ,� "I certify t int p o*rn- �ce of the work for which this permit is issued, I shall not employ any person in such manner as to beco a sub' ct an's Compensation laws of California." Signer Owner p------ By --------------- ------------------------------------------------------ ` l 1 ------ Title .------- ----------------------------------------------------- -- (If other than owner) F�OR DEPARTMENT USE ONLY 7 APPLICATION ACCEPTED BY ----------------I `�=19------------------------------------------------------------------- DATE _----- l — BUILDING PERMIT ISSUED --------------- - -- -- - DATE ADDITIONAL COMMENTS -- ----- -- --- -- ----�`�-------4- ---------- --------------'------------------------- -- ---- -- - ------ ------------ -----------------------�----- -- - -- ----------- - - - --------- -----��---`------------------------- ---- ---------- -------------n --------------------- --------- - -------------------- --- -- ----- �'I -------- --- 4_ __ __________________ ______ __ __ -- __ ------- - --------- - _____------._______._______-_ __-._____________ ___.___ 1R- - r �/ Final Inspects Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M