74-420 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ......................--•-- ..... _ . _. ..._~. .. (Complete in Triplicate) Permit No. . .-- '� This Permit Expires 1 Year From Date Issued Date Issued 5d2,7-:-:-7 Application is hereby made to the San Joaquin Local Health District for a permit to tonsiruct an install the work herein described. This applic tion is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATI N �+ .U_D.- /C �t `.....CENSUS TIC, CT .......................... _4. ._ o. � Owner's Name J ........( 'J l!/�_.�.- --- _..-. . ..�l.lc L--I-.Phone ................... Address ..........:............................ ---------- ------------------------------------- ----- Cit -..........._...._.._ .... .--- .... . ----- ........................... Contractor's Name .. .. c...C�.-k'Ir-rf'�/�- _i�IG.-•--..- ..................License # ..42.75;:1:94 Phone. ._ Installation will serve: Residence ❑ Apartment House-F] Commercial Wrailer Court 0 Motel ❑ Other :. . ................................... Number of living'units:.- ....... . Number of bedrooms ............Garbage Grinder . __ ..._.. Lot Size -------------------------- Water Supply: Public System and name .................... ----------------------- ...... -•----..._.............._.......................----.......Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ 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.) i NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer is available within 200 feet) PACKAGE TREATMENT [ ) SEPTIC TANK S ize---------------------- - -------------------- Liquid Depth ....._.___....... ........ Capacity ��.-_ . �ype 00Z..G..]��.._ Material..( 7eh .. No. Compartments __c?-'--------------- or Distance to nearest: Well 14 ... Prop, Line .340........ LEACHING UNE [ ] No. of Lines ... Length of e9ch line .............. Total Length -66j-0 ............. 'D' Box Type Filter Material .��_,ll-b)epth Filter Material ..... .............. `4 Distance to nearest: Well _ Qrt.@.____ Foundation .... ......_...... Property Line -. .............. 1 SEEPAGE PIT Depth . Diameter ....._.-_....._. Number ._.._. .............. Rock Filled Yes ❑ No C) Water Table Depth ......... •----•------• ---.........Rock Size ----.---•- Distance to nearest: Well ----------------------------------------Foundation ..... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ........ ................................... Date -----------------..-..---..-----..) Septic Tank iSpecify Requirements) ......... -------------------------------------------------------------------------------------- ----------------------- Disposal ---- .-Disposal Field (Specify Requirements) .............. .................... ....... --------- ------------- ------------ - - ----------- ........................................ ---------------------11------------------ ... —...� —A—...................... lDrdw existing and required addition on reverse side) 1 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 subject to Workman's Compensation laws of California." Signed . ------ Owner /I o/� BY - - .. .- �- -- Tale (.iQlli� ............... . ... ...............--------- .._ (If other than ow d FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY .-............... DATE .-. . a. .. y_._.. BUILDING PERMIT ISSUED . . ._ .. .................... ------ -.DATE - .............. --•---- --------- ADDITIONALCOMMENTS ................... ........ . .......---•--._._....-------•--••--.--._...-........_. ......--------------....----.---...--- -•----. ...----....---•-•----. ----•-•. -• ---------- ------- - ------ •----- -- .......................... . . .. . --...... .. ---------------------••------ -- ----..- - ------ --- ------------ .. ..-•-- ......._..... ...-...._ .....--- .-....- Final Inspection by: -- -._. Date �.1... .... ...... ............. 'E SAN JOAQUIt,k LOCAL HEALTH. DI$TRICC'. r l E. H-13, 241•'68 Rev. 5M _ 7/72 3 1�.._