72-339 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------- Permit No. 3- (Complete in Triplicate) --------- j o- This Permit Expires 1 Year From Date Issued Date Issued _S _Z___1.T/ 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 c ---Q7^` ete� /J-�_�` -CENSUS TRACT __________________________ Owner's Name ----- ------ 27----------------- - --- ----------Phone � -3; Address ----� ------- �/ / ---------------- CitY -_-------- Contractor's - --------Contractor's . Name ____ lr � c�� .e!.-- -xi' '-•-_-------.license# f�3__ PhoneGaf_4 ,� Installation will serve: ResidenceX- ApartmentHouse❑ Commercial [-]Trailer Court [ Motel ❑Other,-------------------------------------------- Number of living units:----- _____- Number of bedrooms _.3._____Garbage Grinder __Ak__ Lot Size :____----_ _ Water Supply: Public System and name --- ----------------------------------------------------------•------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt r7 Clay F] Peat E] Sandy Loam F] Clay Loam E] ' Hardpan ❑ Adobe Fill Material _11V___If 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 tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size-----------------------------------.---..------- Liquid Depth .-._____._________._---_- Capacity --------------- Type --------------- Material No. Compartments ...................... Distance to nearest: Well -__--______________________________Foundation ---------------------- Prop. Line ...................... LEACHING LINE No. of Lines _____/---------------- . [ ] � Length of each line-____�12_______________ Total Length ___-�,�--f�._..___________ IN(S j r✓�f 'D' Box ------------ Type Filter Material __3 _��_..____Depth Filter Material ._____/.�.��_.___...__ .............. - _ Distance to nearest: Well .___/�Ct /©--- --------- Property Line --�1 ............... _______._. Foundation ___ ._ SEEPAGE PIT [ I Depth ----- Diameter __ ,. ___ Number -------- _______________ Rock Filled Yes No i❑ Water Table Depth _____ ------------------------------Rock Size Distance to nearest: Well __..__�� ---_________________Foundation I-0----------- Prop. Line _ .............. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _________.-_._--________-------_._) Septic Tank (Specify Requirements) -------------------- -----------------------------------------�------` ----------------------- ------------_------------ Disposal Field (Specify Requirements) _____�f9__._:,_rfi ,ff-- /Z.ef�/---- `------------- ------------ %- �-- tl'1 =------------------------------ ---------------------- (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, I shall not employ any person in such manner as to become ybiect to Workman's Compensation laws of California." Signed ---- / --- - ------ Owner BY - --- -- --- Title - - (If of er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----L -- -------- ----------- ------------------------------------------------------------: DATE ------ -- ✓/ 1 ------ BUILDING PERMIT ISSUED --/ ----------- ----- DATE ---------------------------------------- ADDITIONAL COMMENTS r/ ----------- jC v-------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ ------------------------------------------------------------------------------------------------ ---------------- Inspection by: --------------- ------------------------------------------------------- - Date �I 7 --- ---------- Final SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M