71-573 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -' (Complete in Triplicate) Permit No. --------------------------------------------------------- - ----------------- This Permit Expires I 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: J08 ADDRESS/LOCATION .---.--/b 3- '--3------ ?---5�-- ---- ---------------CENSUS TRACT :- L.-----.�:-� Owner's Name ----------------- ?7vll S------ � Phone - ------------------------------ Addressy��- �1� - fV-----------------------------•-: City , -------------------------------•-------------- --- Contractor's Name rise # ------------------------ Phone ------------------------•- Installation will serve: Residence R-kPortment House❑ Commercial ❑Trailer Court M Motel ❑Other Number of living units:---l------- Number of bedrooms -S,3-----Garbage Grinder O✓,a___- Lot Size Water Supply: Public System and name ------ �-Z- Wr----LSC •----------- Private ❑ Character of soil to a depth of 3 feet: Sand�lt❑ Clay ElPeat❑ Sandy Loam -E] Clay Loam ❑ Hardpan-E] -Adobee-[]- 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 seepa a pit permitted if public sewer is available within 204 feet,) PACKAGE TREATMENT — ]p SEPTIC TANK' Ype Size----lT- �-�-��=f�=------------- Liquid Depth ---�`�-------------- r Capacity (,�,-- _ T �[I_�'C� Matenal(�o_—Z?TPS No. Compartments --- .............. D' Lance to nearest: Well ------------`- ---------Foundation -_lQ_�........... Prop. Line ---- --------- LEACHING LINE No. of Lines ----- --------------- Length of each ------ ------ Total Length -_�-1 p 'D' Box -Pd---- Type_Filter,Material / �• - Depth Filter Material ----- ---------------------•----------- Distance to nearest: Well ----------------_------ Foundation _Ir_----- -_-- Property Line ...... SEEPA(JE PIT [ ) Depth -------------------- Diameter ----------_----- Number ----------__--------------- Rock Filled Yes ❑ No � ,� - Water Table Depth - _ =-Rock Size ---=---------------• �I Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------.----_- - REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------___------ ------ Date -- _---•_- ) ----------------------- f Septi;c Tank (Specify Requirements) -------------__-_--. Disposal Field (Specify Requirements) -_---------------------------- _.11 ---------------------------------------------------------------------- ------------------------------------------- ---------- - - --------------------------------- ---------------------------------------- ------ - - -------------------------------------------------------- (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 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 u , ct to Wor man's Compensation laws of California." G Signed --�'-- - --/ � Lt7 ------------------------- Owner BY ------------------------------------------------------------ Title . --------------- - ---------------------------------------- FOR ---------------- --------------------- - (If other than owner) FOR DEPARTMENT USE ONLY � APPLICATION ACCEPTED BY -------- DATE `' BUILDING PERMIT ISSUED --._--__------_ DATE - ADDITIONAL COMMENTS ---�•t � p rro = 1� /Gs- �- --�� ------------------------------------------------------------------------------------------- --------------------- ------------------------- ------------------------------------------------------------------------------------------------------------- Final Inspection by: ................ . .. Date ---.--_-__- - --------------------------------------------------- a _ SAN70AQUIN LOCAL-HEALTH 'DISTRICT E. H. 9 1-'68 Rev. 5M