74-33 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Y Permit No. ..7�=33__ ---- ------I------ --------------------------- (Complete in Triplicate) - -- - ---------------- P Date Issued .l-a/- 75t ---------------- ---------- �4 _V ---------------- This Permit Expires 1 Year From Date issued 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 -------f-------- - -- - - --- ------------------ ______CENSUS TRACT -------------------------- v Owner's Name --- _ - Phone ------------------------------ _t ---------------- - --- ---- ------ _ 4 / '/ Address �'--/---- J- -- ----- ------- City K-- �' {y Contractor's Name!-�`�� J-----',- ---License # Phone _.6/_43- Installation will serve: Residence (g Apartment House❑ Commercial ❑Trailer Court Motel ❑Other -------------------------------------------- -- "' '--------- Number of living units:____f___ Number of bedrooms ------ ...Garbage Grinder . `__-- .Lot Size --.(�-�----- - ---1---�------------ Water Supply: Public System and name __________________ ___ Loam _____________ ______ Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy ❑ Clay Loam ❑ Hardpan ❑ Adobe 0 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.) (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) s� PACKAGE TREATMENT [ I SEPTIC TANK Size---------P------- Liquid Depth - --- Materialdx1tAo_ _-- No. Compartments -----�.••---_----f Capacity --/�-QL7ggL.Type _.'moi--- - p Distance to neare(sst: Well ____._-______________............Foundation -----/L1_`_--____ Prop. Line -_. :1Q. ...tj _____ Length of each line__._:/-C-3__-____-__..._ Total Length ,_ '. �------------- W LEACHING LINE [x] No. of Lines ._______________ - 'D' Box ---I...... Type Filter Material --------v�_`!-_.Depth Filter Material ___.__..-_ - - - -� Distance to nearest: Well --------- Foundation -------..2.<-'...----- Property Line -._"-"rte ------ SEEPAGE PIT XJ Depth ------ x?___.__ �` _ Diameter Number _. --------------- Rock Filled Yes No E[l aE )/ Water Table Depth -------------------49V--- Rock Size --------c9-- -------- ---------- ---- ---------- ----__.-__ --"'- -------Foundation �0-- Prop. Line Distance to nearest: Well _______._ REPAIR/ADDITION(Pr v. Sanitation Permit# -------------------------------------------- Date ---------------------------------- r an pecify Requirements) -------- ----- / ply_ ----------------- f� Disposal Field (Specify Requirements) _.-__f•,i!.Q_`-- -- t --� ,�__-1- ,X7"- """ '"" ----------------------------------------------------------------------------------------------------------- (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ______ Owner --------------------- - - - Owner------- - = ----------- ---- Title ------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ____ ._ G)�-- ---- dT-Y^ -- ----- DATE --- ---^--2 BUILDING PERMIT ISSUED ------------------- - -------------------------- ---DATE ------------- -------------------- -------- ADDITIONAL COMMENTS ________________________________" _ --------------------- _ Q� a -------------------------------------------------------------------------------------- -3-1�"� t 1�QIY- ---------------------------------- -------------------------------------------------------- - --- ------- --------------------------------------------------------------------------- ------------ ----- ---------- Final Inspection b Date _._.r-. .�1-- - -` --------------------- - - ---------------------- - JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M