71-621 - Laserfiche WebLink

Home Browse Search

.FOR,OF,'". USE: ;. --------- -__4--- APPLICATION FOR SANITATION PERMIT ��`G e, l )Complete in Triplicate) Permit -------------------'-- --------------------- --------------- This Permit Expires 1 Year From Date Issued Date Issued �/ -� 7 -_. 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 -j✓l-5---dF--hfl��yc��E --Yt--�3_Sa--F �T_aF- ll-Lr(S--�DCENSUS TRACT Owner's Name -.;7F4o1'1C.- ._-FV&,54.6A1---------------------------------------- - k Phone . Address ---------- Cit .,$" GXToi✓ f Y - ti Contractor's Name -�Oww.�-- -------------------` License # ------ A: - .Phone Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court '0 Motel Other - ---GM46-4 Vj/ff1V- - Number of living unitsJ1-------- Number of bedrooms` -,,-_----_Garbage Gri"der ------------ Lot Size ---s.J NK-___---------------------- Water Supply: Public System and name --- t - i ----- ----------------------•--------------------•-------------Private 4 Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay at❑ Sandy Loam ❑ Clay Loam [] � Hardpan Adobe Fill aterial ------------ If est (Plot plan, showing size of lot, location of system in relat, to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank o seepage pit p ,ftitted if public sewer is available within 200 feet,) t x PACKAGE TREATMENT [ ] SEPTIC TANKoiete i Size---------------------- - q p " 4� - ;`Capacity _ 1C!'3p Material +Gf�E Na. Compartments _--_ ........:.... 'Distance. o nearv"G________________________Foundation ____/Q --._-- Prop. Line _-5-._--_____-__-- LEACHING LINE [ ] No. of Lines -______ - Length of each Fine-----94________________ Total Length 3.601_---_--_-----.__IF J! 'D' Box ._:.,/___ Tr Material --.,RR-5;-_----Depth Filter Material ----Lq--_-_-__.--_-_- --------•-•----- D.istance'to neare --__,,�Q_____-_--__ Foundation ---�C- Property Line .` ------------------ SEEPAGE PIT [ ] Depth ---_--______---- Diameter, -------___-_--_ Number -.---------------------_____ Rock Filled Yes ❑ No .❑ Water Table Depth i----------------------------- ��-----..Rock Size -------------------------------- i Distance to nearest: ,Well _-- r-_---- ---------------Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation!Permit --------------- - ------------------ Date ----------------------------------) �-rl t Septic Tank (Specify Requirements)y .'�---- Disposal Field (Specify Requirements) --------------------------------------------------------- -------------------------------------------------------------------------- r 3I n -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ ----------- _.._ l r'+ (Draw existing and required addition on reverse side) I hereby certify that I have prepared`thW pplication 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 dgents 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 tF�Wor man's Compensation laws of.California."; Signet! - - --------------------- ----------- Owner ;-- ---------- _ -------------------- ------ Title (If other than owner) i ARTMENT .USP -ONLY APPLICATION ACCEPTED BY.--°` ------- DATE �I 71- V.. --- BUILDING PERMIT ISSUED'---_--- __ -� ------ ---- - --------- ---- ------- --------------------------------------------DATE -------------•------- - ---- ADDITIONAL COM-MENTS -- -- --- --- -- - --- - -- ----- -------------------------------------------------------- --- --------------------------- ----------------- ------ -- ------------------------------------------------------- ------- -- ------------------------------------------------------------------•-- ` -- - -- --------------- - -------------------------------------- ---------------------------------- ------ ---------------------------------------- -------------------------------------------------------- Final Inspection b P Y- ---- ---------- - - ------------------- -- -------------------------- •------------ ----------- ---- -------.Date -- ---------------------------- SAN ------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M