73-1123 - Laserfiche WebLink

Home Browse Search

L`- 1 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT J --ICin Triplicate) Permit No: _7 .-.�� --------------------------------------------------------- This Permit Expires 1 Year From Date 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 applicatiorVis made in comliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI `__ �_____ __- --- - ---- -------��G ------ �� T A_ CENSUS TRACT `c � 1 Owner's Name --------------- ---------1V,4 ---------•-----• ----------------------------------- -------Phone ------------------------------------ Address ------------------ --------------------------------=------------------------------------------------- City ------ le%�,:: --------------------------------------------------------- Contractor's Name --------A. -, �' _ i .-_.License # __ Phone ___ 3 �- U Installation will serve: Residence Ej Apartment Houser] Commercial :❑Trailer Court ;❑ Motel ❑Other ----------- ---------------------------- Number of living units:----- ----- Number of bedrooms _,.'i-------Garbage Grinder ------------ Lot Size -------------------------------------------- Water Supply: Public System and name ---------------------------------------------=--------------------------------------------------------------•--Private Character of soil to a depth of 3 feet: Sand'rid Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan . .� _Adobe ❑� Fill Material ------------ If yes— ape ,__._._.______. (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 seepage pit permitted if public sewer is available Within 200 feet,} ' �� --------- Liquid Depth ------ PACKAGE TREATMENT [ ] SEPTIC TANK�[ ] Size_______��__.I�_�(.�_________ -_____.___._. Capacity ZP-6_-'--'Type & <e!t-S"_"Material----- P No. Com artments _4________________fr Distance to nearest: Well --------;�5?--------------------Foundation ----�/( /--f----_-- Prop. Line _ __-r___-_-_--_ : -S.LEACHING.LINE [ j ; No. of Lines _:___-_?__.,_------- Length of each line-------- ...... Total Length ,_._ ra_.�......_... Materia lType Filter Material l.A'ajDe th Filter of rn Distance to nearest: Well _____._____ Foundation ------------------------ property Line .-_-_- _________SEEP ____ ' AGE PIT Depth ---------- ---- -f Di ameter ________________ Number ---------------------------- kock Filled Yes No .0 : Water Table Depth �- - ---------------------------•-----Rock Size ----- -- -- ------------- Di,stance-to-neares �. Well ----------------------------------------Foundation -------------;------ Prop. Line ----.------------.--_-� REPAIR/ADDITION{PrEv. Sanitation Permit 54` `---------------- ' _-- Date --------- Septic Tank {Specif Requirements} --------------- ------ --_-_-----_-_ -------- ------------------- Disposal Field (Specify; Requirements) --------------- -- ! i ------------------- -------------------------------------------' (Draw existing and required addition on reverse side) - fhereby certify that I have prepared this application and that the work will-lie done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Lncal. 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 ----A 1-4----��=�46-�------------- -------------------------------- -_ Owner By --- - -------- ----- - ------- ------------- -------• Title ----------------------- (If other than owner) -� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... - - ------------------------------- BUILDING PERMIT ISSUED --------------------------------------------------------- -------DATE ------- ----------------------------------- ADDITIONAL COMMENTS ---- ----------- --- -- ' - - r'"� _ _ ._--_---- _ _ _ _ ' --------------------------------- - ------ ---------- __________-_____.___.._______ _______.-__._______._._.____. . Final Inspe b .:.::_ Date P -� ---------- - - -- ------------- ------ -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M �. _