75-572 - Laserfiche WebLink

Home Browse Search

FOR IDF ICS USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) • .....-_. . __ .._U.�...�_� Permit N0. .:'.�.,.�.-.x.72-- ....... . . Issued ..�.-� This Permit Expires t Year From Date Issued Date ......... Application 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 06 ... ... . .. . ... .... -- .. _._ .......... .. ..CENSUS TRACT ............_............. Owner's Name I. .:.. ...... .._._V,--�.E, .... . ............................ ............. .....................Phone `•�� .. ...............` '� Address hrsc e- .............T_.------- City - -..... ........................................ 71 o+�s... ,f G _.License # ._-.._ Phone �....©..- Contractor's Namer. Installation will serve: Residence 9,Apartment House❑ Commercial ❑Trailer Court .❑ Motel ❑Other _. .. . - _---------------- Number of living units:_ /. .__ Number of bedrooms .._�--..;..Garbo a Grinder Lot Si -_. .. .. -. •..... Water Supply: Public System and name . . - _- .__ ._ '_...........Private ❑ Character of soil to a depth of 3 feet: "" Sand❑ Silt❑ Clay ❑ eat❑ Sandy Loam Clay Loam Hardpan ❑ Adobe (VV Fill Material _..._ __ . If yes,type ( `- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ZN PACKAGE TREATMENT [ ] SEPTIC TANK Size.`. ...... ..........__. __ . Liquid Depth .._......-.......... '4 Capacity TypefMateria o. Compartments ----�L '........ Distance to nearest: WellFoundN/ation Prop. tine .._f ..._.... LEACHING LINE No. of Lines �- Length f each ne _...d6 C) ' - Total Length ............................ 'D' Box ._. Type Filter Materia _. -----. ..... ....Depth Filter Material -1.9-11. .......................... � � Distance to nearest: Well -.. 0.!`� _... Foundation Z�-.-- Property line .._.................... SEEPAGE PIT 0(1 Depth D ametertz:;5 - .0-_- Number _. ........ Rock Filled Yes No CJ �- / /..rk v.. Water Table Depth . ------------ ---------Rock Size `tc Distance to nearest: Well ._ ----................Foundation _ - © ..... Prop. Line .... ..-- REPAIR/ADDITION(Prev. Sanitation Permit# ...__... _.. _._._ .......... ...__-.-- Date ..........-------------------.....) Septic Tank (Specify Requirements) ................. Disposal Field (Specify Requirements) ..... . . _ _ _..... __ . ... t ._. ... _.. _._ ............ -- - - -- --- ........ (Draw existing and required addition on reverse side) I hereby certify that I 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, I shall not employ any person in such manner as to s ct to orkma s Comp nsation laws of California. Signed7M .` _...... - - vn� By . Titley (If other than owner) FOR EPARTM WT USE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED _. . _ _. ._ DATE ADDITIONAL COMMENTS .......... - ......... ........ ... ................. ------ ------- _....._........... -- ------- .......-- ......... ✓ ........................................ ........ ........... .......... - ......_. _.. -67. ..-....... .. .............. ..... .......... 'y. r Ux _ _ - ...... .Final Inspection by: . . ,�' '- ' ---Date .: ..._... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.1J,:,24 1-'68 g v M 7/72 3 ,K