72-609 - Laserfiche WebLink

Home Browse Search

j0FFICE APPLICATION FOR SANITATION PERMIT ---------- .. Permit No. -------------- (Complete in Triplicate) Date Issued "-.---- - ' � This Permit Expires 1 Year From Date issued l the work herein Application is hereby made to the San Joaquinnian ecal wi health CounDtytrict for a Ordinance No. 549 and existing Rulesrmit to construct and talnd Regulations, described. This application is made in co p - ..__CENSUS TRACT --- ------- JOB ADDRESS/LOCATION _- /-_v ----I-i1--- s - - ` " - ' ------- Owners Name -- ,,. ,- y - -----o-------- ------- ------------------ Cit Address - 0 n tom' -�"_slice se #. -.--_ Phone Contractor's Name _-X Installation will serve: Residence ]Apartment House-[I Commercial�.OTrailer Court ',E] Motel ❑Other ----------------------------- ' _C''�-/ Lot;Size 1----�'¢��''rf�'�•'�-----••--•- ,_____Garbage Grinder Number of living units:.-/�___.__ Number of bedrooms � private. -------- Water - --- --- - Water Supply: Public System and name ----------------------- --- CIO Loam E Character of soil to a depth of 3 feet: Sand's Silt❑ Clay � Peat❑ Sandy,L-, 7 Y Fill Material ---------=--- If yes,type -------------=-'----------- Hardpan ------ ---Hardpan y Adobe ❑ buildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, , NEW INSTALLATION: (No septic tank or seepage pit perif public sewer is available within 200 feet,) /"f -_ 1 -�1` Liquid Depth��-- ----------#,- 6) 1' PACKAGE TREATMENT [ ] SEPTIC TANK'�j Sizej-��"' � e Capacit / - T e a?,-Ve-' `'!-- Material No.`Compartments -"--- •-- ---- y - - -V�----- YP ` Foundation __l ------ Prop. Line _ � :---- - Distance to nearest: Well --l-49-6----------- ...i / ) r� "'` Length of each line--- _ Total Length /f_7G')...-------'. � 1A No..of Lines " " LEACHING LINE ____ _ r� . � _Z -_ Depth Filter Materoaf/�-- D' Box �I Type Filter-Material/, -----� f � ^ _ Property Line ------•- �1 --____ Foundation i Distan to nearest: Well _ i„ ' Diameter ------ Number ----- ---------,-� Rock Filled Yes } No . � - - De Depth ---------- Water - - � SEEPAGE PIT ,j�� P -�� - °-•� - - --•------•---Rock Size - �� Water Table Depth ------ -=42------- ------ - .r - Foundation _. b�k Prop. Line. *�-------••-:-. Distance to nearest: Well _ - - ti Date ---------- •------•l REPAIR/ADDITION(Prev. Sanitation Permit# --------------------- T --------------------- Septic Tank (SpeciffyRequirements) ---------------------.--------------------------------- -F.ieldz{Specify Requirements) ---------------------------------- Disposal' --------------------------------------------------------------------------------------- - ------- ------------------------ ------------- -------- ------------------ 4 = --------=--- ---- - I. ' ' (Draw existing and required addition on reverse side) ; � .1 hereby certify that I have prepared this.a>nh Son Joaquin di Re4 ulati nsand tof the San Joaquin Localhat the work will be oFlealth District. Homeowner or 1 cen- County Ordinances, State Laws;and Rules a J .° sed agents signature certifies the following: in such manner "I certify that in the performance of the work for wh'sch this permit is issued, I shall not employ any person, . as to become subject to Workman's Compe'sation laws of.California." Owner Signed / � ---------------------------- -- k_ By ► / ------- - --------- -- -----= ` Title /F, - - other than owner) FO PARTMENT`USE O LY �" y \ DATE . , - APPLICATION ACCEPTED BY -"- ---- -- --- -- ---- -- -------------------=-------------- DATE _ ' BUILDING PERMIT ISSUED --- ---------------- ----------- .-----------s------- ---------- ----------- -=----------------- - --- -- ADDITIONALCOMMENTS ------ ---- -- -------- - _ ------------------------------------------------------------- ----------------------- ---- ----- --------------- - ---------------------------------------- ---------------- ----------- --- --- - - --- - - Final Inspection by - ------- ----- ---------2�? SAN JOALOC HEALTH DISTRICT ,, t u 0 1268 Rev. 5M