73-32 - Laserfiche WebLink

Home Browse Search

5 FOR OFFICE USE: pppLICATION`FOR IANITATION PERMIT ---- ------------------------------- ----------------- - , Permit No. 7 2_ 3A IComplete'in-Triplicate) - -------------- ------ ----------_- Il_11,30 `!'! ' '-------------- 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. Qo,VE10A1I Alt.14 JOB ADDRESS/LOCATION -----------------------CENSUS TRACT ------------------- ...... �_ ------------------------------------------ Owner's Name ------- -�----�------- -- -- - ��t-� ----------- ------Phone -----•- Address.----------------- ------ � City_ ----- ` - - ------------------------------- Contractor's Name ------- `-� [ -------------------- License # L ?_� ------ Phone Installation will serve: Residence ❑Apartment•House-❑-C-ommercial:❑Trailer Court. ❑-- - - Motel ❑Other Number of living units:-----[------ Number of bedrooms -_- _Garbage Grinder .______ Lot Size - ____ - Water Supply: Public System and name --------------------------------:---.-----------------=----------------•-- ------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay,Loam] Hardpan ❑ AdobeN 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,) `� O PACKAGE TREATMENT [ } SEPTIC TANK S' e___ `�� ,f____i_____________________�'- ,,Liquid Depth _� ___-_-________• Capaci _ ---- ----- _ Type < '---- Material-_ -t_ No. Compartments ...................... � ----- - - - -- - --- Distance to nearest: Well ------IrO-_�_________________Foundation ----f_p----------- Prop. Line ---------------------- LEACHING LINE f No. of Lines _._.__f_____________ Length of each line-------��__�_.__-___ Total Length _100._ _____ '~1 'D' Box ------------ Type Filter Material _i _____Depth 'Filter Material ----.«. -----------________________ r � Distance to nearest. Well _____ U_7`_-____ Foundation _-_. a__7--------- Property Line ________________------ SEEPAGE PIT Depth __,A..-_---____ Diameter __ -------- Number --------- - ockFilled Yes No Water Table Depth --------------------------f----------------_---Rock Size i Distance to nearest: Well ------l0_------ __f________________Foundation 77:7_ Prop. Line _____---__--__-____-__ a REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________________________________1 SepticTank (Specify Requirements) ----=------------------------------------------------------------------------------------------------- -------- ---------------------------- Disposal Field (Specify Requirements) ____-___-_ ___ ------------------------------------ (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 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, I shall°not employ any person in such manner as to become subject to Workman's Compensation laws of California." zk' Signed W444 Owner �^ BY -- - ------------------- - -- ------------------------- -Title f/l --- --------------------------------------------------- (Aother tner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPT6D BY�_ - n----- ---------------------------------------------------. DATE --- �- 3-------------------- BUILDING PERMIT ISSUED . ----------------------------------------------- --DATE ----------------------------- -- ---------- ADDITIONAL OMMENTS _ _____________ __-_ --- - ------ `- ----- °' +tet.--— - z-- - -_ - , -- ---- -- ---- ------- - -- Final inspection by: ----- ---- -- --- -------------------- -----------------------------------------------------Date ---- SAN JOAQUIN LOCAL HEALTH DISTRICT kD F_ H_ 9 1-'AR RP-V- 5M '