75-973 - Laserfiche WebLink

Home Browse Search

FOR..OFFICE USE: APPLICATION FOR SANITATION PERMIT �� Permit No. _7_S--_�23. --------- -------------I------------•-- - ----------- --- (Complete in Triplicate) ... �1--------------------------------- Date Issued l}------------7S This Permit Expires t Year From Date Issued ------------- 1 Applicat on 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. 349 and existing Rules and Regulations: JOB A LRESS/LOCATION . T- -�.------- CENSUS TRACT J� � _Phone - .3 _3 1 Owner's' Name _ .--- -------- --------------------------------------- --------------:---- q 6 r� ------------- ------------- ---- �l�llr�i -�.�t -------------------=•------------•------ Address ---�- _ O >� --- � ---_.__. City _ -_-- - --- - '- --�-W- -------z"e _ - Contractor's Name .L�/. FJ1 KGs --------- License # ?SSV--- Phane c�_ l�n t il, i _ _ �Residence" Apartment House❑.Commercial ❑Trailer Court Installation w� serve Motel ❑Other ---------------------------------- --------- Number, of living units:-.__._'.._ Number of bedrooms ---3-____Garbage Grinder ------------ Lot Size ____ --------•-------- -----Private Private Water Supply: PublicSystem and name ---------------- ----- --- -- ----------------------- I Character of soil to a depth of 3 feet: Sand'❑ Silt F-1ClayE] Peat El Sandy Loamr% Clay Loam ❑ Hardpan ❑ . Adobe❑ Fill Material --___.______ !f 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 p flank or seepage pit permitted if public sewer is available within 200 feet,) . i 6 f PACKAGE TREATMENT [ ] SEPTIC TANK [ l 5ze__' X_a9�� = ------- Liquid Depth .a ----...--- t Capacity ------- Type fto Gl�aterial---------------------- No. Compartments --- ------------ Capacity t Distance to nearest: Well Imo'----- -- ------------Foundation I�-------------- Prop. Line s ____._.____.---- LEACHING LINE [ j No. of Lines -3----------------- Length of),each Mine ---------------t Total Length �_c 1 ------------ -------- ------_--.- D' Box -1_.__-_ _ Type Filter Material�lo'��rrc _�.Depth Filter Material -- __ Distance to nearest: We ' 7 e Fi .r1 II �Q� --------- Foundation a5------ -�- Property Line- -J�------------------- I � 5 ! SEEPAGE PIT [ � Depth ____-_._.__-- __-- Diameter _______--______ Number ------------- .--- Rock Filled Yes ❑ No )❑ I � { WaterTable Depth ------------------------------------------------Rock Size __.,r---------------------------- I Distance to nearest: Well --______________ Foundatio -_____.--= Prop. Line .._._____-.----------- ------- ---------- REPAIJADDITION(Prev. Sanitation Permit# -------------- ----------------------------- ) f. S - -----.._--eptic Tank {Specify Requirements) _.___ ------------ ---------------------------- 1 41 Disposal Field (Specify Requirements) ------------ ---------------------------------------------- ----- .I l ------------------------------ --- ---=------- }_- ---------------- = ------------------------------------------------------------------------------ -- (Draw existing and required addition on revgrse side) I hereby certify that 'I have prepared this application and that the work ll/be done in accordance with San Joaquin /. j 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--_..-___ -- "1 certify that in the performance of-the.work for which this permit is issued, 1 .shall not employ any person in such manner > > as to become sub' to ork 's Compensation laws of California." Signed _4 = x Owner , t'• ` (If othe� than owner) ,- FO EPARTMENT USE ONLY APPLICATION ACCEPTED BY --- - ---- ---- ------------------- ----------------------------------- DATE ----��- _.. ---------------- BUILDkf�G;PERMIT-iSSIJED- ----------------------- --- ---•. - .. ---- - DATE ---- -- --- ADDITIONAL l COMMENTS ---------------------------- -`----------------x- --._---:-------------------------------- ------- -------•--- ------- ----------- ~(1r=----------.-.-u-�--_--.---.-_-----_----.- .--..�---_ ------ -----t. -------_ _ ---_----- ---;-------.-..- --- -- _m�---;--.---------------_:-----------_ _----- --•---- ----------------- ------------------------ a4 Date -- � ---------------------- Final Inspection b _ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9� 1268 Rev. 5M