73-156 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR� SANITATION PERMIT Permit No. ------------------------------------------------- ---- --- � [Complete in Triplicate) 30-7 ---- ------------------------------------ -------- Date Issued _. This Permit Expires 1 Year From 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: r JOS ADDRESS/LOCATION ----�L'JO -- ---- � �� CENSUS TRACf ----5`-- -- Owner's Name s ++�ryry-- = Phon,,e/ Address '� WA -I t �•"•• City ---------E..SC_1__a V----------------------------------- Contractor's Name __! I _r ;- !'----- - ----- -----------------------license # ------- - ------------ Phone ------------------------------ -- {"i y �c Residence R•partment House Commercial ❑Trailer Court ❑ F Installation will serve: ._ -. l Motel F-1 Other -------------------------------------------- n Number of living units:_.!_--_____ Number of bedrooms _____..Garbage Grinde/..�- Lot Size -17 Ill Water Supply: Public System and name' ----------------------------------------------------------------------------------- Private z� r. -- -Character of-soil-to-a-depTh-of-3 feet:--.Sand-E--Silty]-f�=Glcrp7B P'eai~C�--Sandy Loam []� Clay Loam [ #- 1 iz Hardpan Adobe'❑ Fill Material ------------ If yes,type ______________________ r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ,or,seepage pit permitted if ublic sewer is available within 200 feet,) q { - � NEW INSTALLATION: [No septic tank Size__ _1 __�!_-- ------ �Liguid Depth ___ ---------- y PACKAGE TREATMENT [ ] SEPTIC TANK k: ,, G. .. 1J�� _- T e _ X095 Material Cf�L1/� ! No. Compartments ___-------" ; Capacity t� Yp r [ is ance to nearest: Well _----��- "- _Foundation _0A-------"- Prop. Line -___ ` LEACHING LINE No. of Lines Length of each line----- - ----- Total rLength ----' ---- I.1 ✓✓ D' Box __ Type".Filter Material �Q"�._l --Depth Fitter Material --------------------• ----------- 1fif r #;, f Property Line -�----••---------• Distance to nearest: Well --. --------------d Foundation _____� -------- -- P rtY __ Number _.___._-r.-----�-- -- Rock Fille Yep Na ❑ SEEPAGE PIT Depth -- �-- -_- -- Diamefier __ "� - s: , Rock Size -/ "-� - - Water Table Depth ----- - -------------------•----•--•------ � +. � - i y� �" --.--------Foundation __� -- Prop. Line . Distance to nearest: Weli ___�"_C!___-.-_""--- - -�i_•, 1. REPAIR/ADDITION(Prev. Sanitation Pbrm'it# -"',...._------------------ Date ------•------------•-------- 1 ---- ----------------------------------------------- - Se tic Tank (Specify Requirements) --------------------------- - - - p p Y q fir•';---- :-�----- Disposal Field {Specify Requirements) -----` ------------------------------------------- ---------------- ------------------------------ = ... ----------f----- --- --- -- -- _ --^--- ----- ----i -- ---- -.�- - � T"----- -- -- -------------- a--- (: i ;quired addition on reverse sidef•-•--•. -•--- ; (Draw existing and_re � � I hereby certify that I have prepared this app nation and that ;the r o Ili be done in accordance with;.San, Joaquin County Ordinances, State Laws, and Rules and Regulations of the Sari Joaquinitocal Health District. Home owner or licen- sed agents si ature certifies the following: "I certify t in the pe rf nce)sompensaflon he work:for which his permit is issued, I shall not employ any ersorf in such in ner Y as to bec a subject to o malaws:of.Ca.lifornia.'�...,.. �.-� .� �• } Sign li Owner �. �"c' *-� p�j f -----f--'- irs-- Title --------------- --------------------------- ----------------------- $Y F , wT ` {lf other than owner) ;-+ FOR .DEPARTMENT USE ONLY .� wt �� ---- f------�. DATE 1-`. � 4 APPLICATION ACCEPTED BY _____�__.- - ;-- -- k R ----------------------- ---- - ' DATE 4 BUILDING PERMIT ISSUED a .�' ADDITIONAL COMMENTS ------------ ---- ---------------- - - - --------------------- ------------------- ------- .� ---- - = -----------_ _.._..._.__ ---- -- ----- - u. - Final J,�speciiors. Date�.�: .:�_`-----�-._ ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 11-Z_73 - x E. H. 9 1-'68 Rev. 5M _