73-372 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE:., ' AFPLICAGN FOR SANITATION PERMIT x ............... M� y Acomplete in Triplicate) Permit No. .. ••• •• -• This Permit Expires 1 Year From Date Issued Date Issued .>> 7� -3 Application is hereby !!rrte� s/ PP y made to the San Joaquin local Health District for permit o construct and nstalithe work- described, This application is made in compliance wit C unt lnan No. 544 and existing Rules and Regulationsrein JOB ADDRESS/LOCATION l.t ....... .. .�'.s: CEN5 S RA .......................... ..... . ... .... .. . . .. Owner's Na a ................ .......... Address --- .. .. ......... ... ......................... City . ---••.......... Contractor's Nome _....._ ....... . . ...... ..License # Phone .........�'1. -4 Z Installation will serve: Residence(Apartment House Q-Commercial ]Trailer Court 0 f�- Motel ❑Other.: ................. Number of living units......_, Number of bedrooms .._ ......Garbage Grinder ..+. lot Size ..................... . . . Water Supply: Public System and name y PP Y ......._...---- _.,:z rive [] ...Private Character of soil to a depth of 3 feett Sand 0 Silt -Clay ❑ Peat❑. Sdndy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ F.iII Material ............ if yes,type .....-.-__--------------- (Plot plan, showing size .of lot, location of. system In relation to wells, buildings, etc.' musi%e placed on reverse side.) NEW INSTALLAYR6N: (No septic tank or seepage pit permitted-if public sewer is av ilabl within 200 feet,) PACKAGE TREATMENT �[ ] SEPTIC TANK ) Size. :"`: ,Q •-. Liquid Depth .................. .. Capacity .1.............__ Type ...................... Materia l...................... No. Compartments ...................... t Distance to nearest:\Well Q.p _.: ...Foundation ..__/10............ Prop. line LEACHING LINE [ Na. of Lines _........ _--. Length of each line.----_-----.--- ----- oa Total Length .......... GSL.... ........_.. D' Box ...Z__,�-Type Filter Material .:..h: '...Depth Filter Material . Tr Distance to nearest: Well ........................ Foundation ...._.... .............. Property Line ....__. ............ SEEPAGE PIT [ ) Depth -_.._ . �- Diameter .. Rock Filled Yes ❑ No p �.... !•�.. : .lC�.. Number ....----�...._........ Water Table Depth r P ................................................Rock Size ----.....----......_._... ...... �, 0 tiw f`� a Distance to nearest: Well ....................:...................Foundation ____._.......___..._ Prop. Line ..................... C REPAIR/ADDITION(Prev. Sanitation Permit# .. Date ................ ) Septic Tank (Specify Requirements) ...._.._..................................... •-'•..................... .............................-.... 'Disposal Field (Specify Requirements) ' ...............................................................................I....................._.... .... ...... - (Draw existing and required addition on reverse side) F I hereby certify that I have prepared'this application and that the work will be done in accordance with San Joaquin M 'itCounty Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or lice". s' agents signature certifies the following: ( �.1 eertify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner "�as'to bee�vc' n's pensatlon s of California." Signe ... -•-----•- . -• ••••--••.I................ Owner By ........I...........................I....-••-•-...,:...... ..... Title (If other than owner) ............................... FOR DEPA TMENT USE ONLY APPLICATION ACCEPTI D BY ... .. .. ...... ........ ---- .......... .. ..... DATE . ... :. i -..... BUILDING PERMIT ISSUED ...._------ _ ADDITIONAL COMMENTS ......e rrrx�!u.�_.... i `fr�..,�a' .zc �� 6. .:... .` .. A7 r .�_-- .j.s_... u ..,fcc�kcy e... ............................................................... :.. _ Final Inspection by" . . . ...... j ...... '........ ............................................................ .. ----`----- -• �� ........•---••••--. .... . ..............Date ....o..~.;��.-.: _._... SAN JOAQUIN LOCAL HEALTH DISTRICT 4", 'E. H.13 24 1.'68 Rev. 5M