73-462 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT ----------------- .. . (Complete in Triplicate) Permit No. _�3- _--- --------------- ---------------------------- This Permit Expires 1 Year From Date Issued Date Issued = _3 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 ._,_�.f2� 37C ___r ---__- )_RT- _('_f�____._____________CENSUS TRACT __ -X _______ Owner's Name u'------ ----z-�-I9FF4R 0� -------Phone _ --- 23-70 �- �Tl`� V - City -- e ,� Address _.._____ _ � �_�-/7�-�1�f' Contractor's Name ------ 4&/NSZ._. --- ---------------------------------.License # ------------------------ Phone ------------------------------ Installation will serve: _ Residence partment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ____ Number of living units. -_ _ _. Number of bedrooms _-Garbage Grind , v er _6-__"—Lot Size -�REA- -_ Water Supply: Public System and name -------------------------=--------------------------------------------•---------------------------------------Private Character of soil to a depth of 3 feet: Sand Z lf❑ Clay ❑ Peat Sandy Loam ❑ Clay Loam HardpanAdobe Fill Material If yes, type ---------------------------- �j W (Plot plan, showing size of lot, location-6f system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage `pit permitted if p(iblic--sewer is-availa 'e within 200 feet,) PACKAGE TREATMENT [ ]- SEPTIC TANK [ ] Size-------------------------------------------- -__ Liquid Depth -___----____--_--__-_.-_- Capacity - Type -------------------- Material - ------------------ IN o. Compartments ...................... Distance to nearest: Well _____ ------------------------Foundation ______ -------------- Prop. Line _.________-____.-__-_- r) LEACHING LINE [ j No; of Lines ___________ _______-_ Length of each line------------------- Total Length ,__-__---_-_----_-.._------ 'D`Box -.______--_ Typ Filter Material ___________________Depth Filter M teria) ---_--_--_-_-_----_.--_----------.--.-_---- Distance to nearest: ell ________________________~Foundation ______._______._ _____ Property Line _________.______..._.__. SEEPAGE PIT [ ] Depth . ------------------ Diameter ________________ Number _________________._ ----- Rock Filled Yes '❑ No i❑ Water Table Depth -----------------------------------------------Rock Size --------- -- -----•------------- Distance to neares : I -____.____-__________________________Foundation -- - -_____-.-_ Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ___________________________(------------ Date -----;_____--_-_ __-_.____.._____) SepticTank (Specify Requirements) --------------------------------2_5- --------------------------------------------------------------i-----------f----------- y v Disposal Field (Specify Requirements) ------ P------ ------------- ., �-cfL�_n,c __-______f .X XI�---_-_- - P --- -- r r- -- ----- --------------- (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 si nature certifies the following: ,; "I certify t iWte rfor once of the work for which this permit is issued, I shall not employ any person in such manner as to beta a sW man's pensati.on laws of California." Sign d ;-------------- ------ ------ ---- - -- Owner ----------- ----- - - - - By ------------------ ---------- ----- ------------------ ------- ----- ------ Title ------------------------ ------------------------- --------------------- ------- other than owner) FOR DEPARTMENT .USE ON Y APPLICATION ACCEPTED BY --_. .((K� ------------------ ------- ---------- --_ -------- DATE -------- - --:__ D_='77 BUILDING PERMIT ISSUED ---_ -- - ---- ---- -- - ---------------------------------------------------- - - -------DATE ------------------ ----------- ---------- ADDITIONALCOMMENTS -------------------- ------------------------------------ ------------------------------------------------------------------------------------------- -------------------------------------- --- --- ------------------------------------- SAN - - - ------ ----------- ---- --- - -- -- --- -------- ----- - - 7 Final Ins Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M