73-27 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE; ----------------------------- APPLICATION-,FOR SANITATION PERMIT .• a (Complete in Triplicate) Permit No: This Permit Expires 1 Year From Date Issuedr F 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 11 549 and existing Rules and Regulations: r b JOB ADDRESS/LOCATION _.t1 J_ l}._ r ---�" - " Qf�-- -- -_.CENSUS TRACT Owner's Name ---------- ------------- - -- - - Address Pone �s� - . - - - r . City . ----- -- -fir r Contractor's Name "f -- _ - /-/ 'Phone --------License # �=- -- e ------- - -- ----- ---•- Installation will serve ResidenceApartment House❑ Commercial":❑Trailer Court ❑ ; ,r Motel,❑.Other ----------- ----------------------------- Number ofliving units:____ der 11 ___. Number of bedrooms f_ _ _ -- LotSize r f Water Supply: Public System and name __Garbage Grin ,--`------------------------------••- - -- - _---- - ----- - --------------Private -- --�::-Character of soil-to a depth-of 3 feet:--'�-`Sand❑ Silt❑-— Cla y [D--Peat-D-+--Sanfl�Clay-l:oam� - <-. Hardpan ❑ Adobe'[] Fill Material ------------ If yes,-type --------?------------------- (Plot plan, showing size-Of' lot, location of system in relation to wells, buildings; etc. must bejplaced on reverse side.► ,- `GJ NEW INSTALLATION: ' (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK; � [ l �a Size ------ Liquid Depth -------------- t'' ---•-------- Capacity Type -' � Material------------ --------- No. Compartments ------•----- �p'4k Distance to nearest: Wel! --------------- Foundation_ R ------------ - ---- -- Prop Line ---.----•---- ' LEACHING LINE No. of Lines Length Weach line_: <,_ ---- __ _ Total Length i 'D' Box ------------ Type Filter Material --------------------Depth'-Filter•'Materiai Distance to nearest: Well °________ f ` ' ------- ----- Foundation'""'-------------------- ------- �- Property Line --------•--•------------ ; SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ':�_-I------------------- Rock Filled Yes ❑ No C]Water Table Depth ___F_-'_ _------------------------------------.-Rock Size Distance to nearest: Well ..:____ _•_____________Foundation._=____-------------- Prop. Line ........-............. REPAIR/ADDITION(Prev. Sanitation Permit s/# _._:'________________________ i ------ Date Septic Tank (Specify Requirements) _________ ' - . ------- ----- ----- - - ------- i -------------- Qisposai Field (Specify Requirements)' It-- ------ .��/�� r v -.. ___ __ ____ _� - ------------------------------------------------------------------ (Draw existing and required addition on reverse side) ' I hereby certify that I have prepared this application and that the work will be dor.ne �n accor`dance 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 performcince of the work for which this permit is issued, I shall not em to an as to became subject to Workman's Compensation laws of California." p y Y person in such manner Signed ----- ---------------- ' Owner a - ---- - -- ...... ---- . - ----------- Title , � • (If other t owner) ------------------- 4 R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- BUILDING PERMIT ISS EE ---------------------------------- ---- DATE -- ADDITIONAL COMMENTS ------------------- __DATE -- - 1. _ ------------ ------ --------------------------------- F__ �._ �Y --- ---- -- _ �-- .. '--- ---- ---------------- ---._ter _. ---- ------'---------- ----------`-- --- --- -- Final Inspection by: -Ca-_V- _- -- - -----------Date --- .--- v SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'613 Rev. SM