75-235 - Laserfiche WebLink

Home Browse Search

F ,.FOR OFFICE USE: 16,976 APPLICATION FOR SANITATION PERMIT /0 7 ........................•-•......._..•-••-•-••--•_.... Permit No. -7,15-- .13 S_ ' (Complete In Triplicate) •----•-•............. . This Permit expires 1 Year From Dots 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: +7 J �J �—• JOB ADDRESS/LOCATION .. ......_.L W I {f..... 7 a-� ..........CENSUS TRA//CT ....... ............ Owner's Name .. . • • -•••......................•...._...._,_.. ......-... .: s_._ .Phone Address /- ...... .-.... .._...........Cl, .._ .... . ...... Contractor's Name �.- _ s .. ................._.License 91t ___ Phone Installation will serve: Residence Apartment House] Commercial❑Trailer Court 0 Motel ❑Other-----------•.....................•-----•--•- Number of living units:------------ Number of bedroo s Garbage Grinder F Lot size a sX :1 ..... ...... Water Supply: Public System and name .............................................Private�]. Character of soil to a depth of 3 feet: Sand[] ift 0 Clay C,] Peat❑ Sandy Loam 0 Clay Loam❑ Hardpan❑ Adobe UW Fill Mater€al _..._._..... if yes,type............... ............ #Plot plan, showing size of lot, location of system In relation to wells, buildings, etc, must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 240 feet) PACKAGE TREATMENT l ] SEPTIC TANK[ } Size.............................................--Liquid Depth ........................... Capacity ---------- --- Type -------------------- Material..-------•----•----- No. Compartments 1� ---------------------- i Distance to nearest: Well R Foundation ..... Prop. Line ..__..J LEACHING LINE [ ] No. of Lines ........................ Length of each Eine•----------.._..___ --__-- Total Length ............................ 'D' Box ............ Type Filter Material ....................Depth .Filter Material ............................................ � Distance to nearest: Well ........................ Foundation --- .-._-_------_- Property Line ........................ 1 SEEPAGE PIT [ ] Depth ------------ ....... Diameter ..........:..... Number ------_---------- Rock Filled Yes ❑ No Water Table Depth -•--•...........................................Rock Size ................................ Distance to nearest: Well ........................................Foundation --_____.__._._ ..... Prop. Line ... ................. REPAIR/ADDITION#Prev. Sanitation Permit# ............................................ Date .__........................._-----} Septic Tank (Specify Requirements). ... ........... ...... .. ....... ............................................................ Disposal Field (Specify Requirements) ............... i ------------------------- -----------------------------------------•---------------...-------------------------------- ------------•-•--•---- ........ ................................•------:.... - (Draw existing and required addition on.reverse side) I 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 Healih:Dlstrlct. 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." SBYigned - ----------------------------------Owner -�r�_ - -- -�'�-- •- -----•............................. Title -----. -------------------------------------------- FOR-DEPARTMENT --...-----------------.....-•------•-----••FORDEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------•---------••-----•---------•---•- .....................DATE . �1..'� 75. ---_------------ BUILDING PERMIT ISSUED ....... ,_:..__-- _ DATE .........................................COMMENTS ..... .. .99A?/.2.... --------------------------------- --------------------...---- -------- ---•----- ---•-- --,......,.. .................................. --------•----•---- ---- -•- ----------- •-• fjs"j ----•-•--•----••---- -•-----•............ . ..................Date �/� � FinallnspectionbY EH 13 2h 1--68 �-.Iiev- 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M