73-974 - Laserfiche WebLink

Home Browse Search

FQR OFFICE USE: APPLICATION FOR SANITATION PERMITY - ---------------- ---------------------- --------- — -- (Complete in Triplicate) PertNo. __7� -------------- This Permit Expires 1 Year From Date Issued Date Application is hereby made to the San Joaquin Local Health District for a permit to constructandinstall the work herein ad described. This application is min compliance with County Ordinance No. 549 and ex?Sin >.� Rules and Regulations: JOB ADDRESS/LOCATION ___ _ ___ ____ - _ / _ __Q- __- --CENSUS TRACT __________________________ Owner's Name ---- - f:' ----------�� -!-'I_- -- - --Phone Address f -- -----1 1 ----------------- ' 6----- City Contractor's Name - ----------------------------------------------------License # ----- ---------- ------- Phone ----------------------------- Installation will serve: Residence]%Apartment House❑ Commercial ❑Trailer Court Motel ❑Other - ----------------------------- Number of living units:-_ ------- Number of bedrooms ---Q_-----Garbage Grinder --- --___ Lot Size _-_fie---- l .......... 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 2- Fill Material ------------ If yes,type ____________________________ (Pl'ot 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,) _ PACKAGE TREATMENT [ ] SEPTIC TANKX Size........... `_ _-_ -_ Liquid Depth ____f ----------- Capacity --1'V-0 ''atT,pe -F'' "------------ Material.- No.V11Compartments ----_��. ...`._.... M Distance to nearestJI : Well _______ Foundation ______/--Qr______._ Prop. Line ....IQ_____-•--. LEACHING LINE ) No. of Lines g r g r' - _-__-_-�___________ Length of each line___--��__.�__ Total Length _____.��__ _________ 'D' Box ---1------ Type Filter Material ____ _____Depth Filter Material ------/_Q____ --------_.............. 9 f Distance to nearest: Well ----- --- Foundation ---/ ___--____ Property Line -------- ............. SEEPAGE PIT Depth -------' Diameter —1-71----- Number -----------/------------- Rock Filled Yes IV No i❑ Water Table Depth ----------------5G--� Rock Size --------I--------- -----------: �i Distance to nearest: Well ______r_____ _________________________Foundation ______f t'l_.____ Prop. Line _._°s�.A�'___._...__.V REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________-_______--___-______-_--) Septic Tank (Specify Requirements) p {�------------ -- --------------------------- ---------------3 . r Disposal Field (Specify Requirements) -------- ------ � .•'_ ._ -<<"= _. _____________________,__ --- > --- ---- -- Draw existing and required addition on reverse side) I hereby certify that 1 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, 1 shall not employ any person in such manner become subject to Workman'sr pmpensation laws of California. as to bec �� Signed --------`�-�`-`----� ��--=- ----------------------------------------- Owner r �a By ---------------------------------------------- ----------------------------- ------------------------- Title ----------------------------------------=----- ------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE '"_ _ __'" _________ /'C -------------------- BUILDING PERMIT ISSUED ---------------------------------------------------- --------------------------------------------------DATE -------------------------------------------- ADDITIONALCOMMENTS --------- ------------------------------------------------------------------------- ----------------- ---------------------- -------------------------------------------------------------------- --------------------------- --------------------------------------------------------------------- ------------------------------------ --------- ----------------------------------------------------------------------------------------- --------------------------------- ------ - - - - - ---- - -- Final Inspection by: _ _ c✓ ---------------------------------------------Date ' T�- - -----------=------- ------------------- SAN JOAQUIN LOCA*-HEATH DISTRICT E. H. 9 1-'68 Rev. 5M