72-16 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE . APPLICATION FOR SANITATION PIRMIT (Complete in Triplicate) Permit No: .. ..�o -- -- .. -- ...... ....... This Permit Expires 1 Year From Date Issued Date issued ___;!'1._Q_:_7 Z Applications 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. 549 and existing Rules,and Regulations: JOB ADDRESS/LOCATI N .__ ..__.fl----. --_.7-L : -' --_-- vl__�-----CENSUS TRACT --------------=- - ------- ty Owner's Name --•-• --- ----- ---. ..... _...... .. - :PhoneAddressf ' - / /� City Q ZoRttactor's Name . L „d, �,�d - �d.CcL� : ►e C�License #o��v -°��-- r��.. Phone _ Installatioivwill serve: Residence ErApartment House[] Commercial QTrailer Court C] Motel ❑Other.................. ................... Number of living units:----- Number .of b Brooms -. .._ Garbage Grinder -4.4e- Lct Size �C 7 Water Supply: Public System and name - . ..... .................. ........ . .. ........ ._...-<......................- .._ . ...........Private, Character of soil to a depth of 3 feet: Sand E] Silt p Cloy ❑ Peat E3 Sandy 1.00'"10 Clay Loam]R Hardpan Adobe. ,Fill Material - Ye -- =----- If s,type ._ ..... p �` '� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must he placed on reverse side.) NEW INSTALLATION: (No septic,tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK)W Size--- .` a Liquid Depth ... .... . Capacitylald"9.6,41-Type Material._ Na. Compartments ,...AP2.......... f 01 Distance to nearest: Well _- `d..... ................Foundation ._AQ .... ........ Prop. Line.._�....... .... LEACHING LINE X No. of Lines -----,l-------------- Length of each line._;-/,?__47-------------- Total Length'. .e. ......... V Box :l1� ,,rr�� r* --- :Type Filter Notarial ..iC' .___.Depth Filter Material __-•. .. :................................. oe ` , Distance to nearest: We11 --sS� ............. Foundation -------Via'-___.__.... Property fine z "`,_-::.- ........... SEEPAGE PIT ]" Depth ._ ...... Diameter . ' Number --------------- Rack Filled Yes'-Lt No 0 Water Table Depth --- ------ --.Rock Size - ': `�_......... - D'istance to nearest. Well ._- d. . ..........................Foundation-.:. C. _,....... Prop. Line_...�-----. ---. REPAIR/ADDITION-(Prev. Sanitation Permit# .... ..._-_ _-__ Date ..... ) Septic Tank (Specify Requirements) ----- � � r _� � .. - Disposal Field (Specify Requirements} ---------------------------- --------- ...................... ---- - --------• ••--- .,,F. (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this appNeation 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 whish this,pormit is issued, l shall not employ any person,in'such'manner as to become subject to Workman's Compensation laws of California." Signed : _Owner Title s SY ----------------- _ r C� ...... (if other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. - DATE 1f ...3.`."�` ...................' BUILDINGPERMIT ISSUED`-------------------------------------------------------- ....................•=- ------- ------ ....DATE ------------------------------------ ADDITIONAL COMMENTS,« ------ ........................ ------------------ ...................... r ------------------------------ .-- Final Inspection-by: .-----•----�!,moi ------•--- ----- -----• ----- Date;. _ �" SAN JOAQUIN LOCAL HEALTH 'DISTRICT E,H. 9 1-'68 Rev. 5M .:>1d° 3 r-