73-1048 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,�// ----------- Z�t`-z�� Permit No. __73-1�f -- (Complete in Triplicate) ----------- - - - --------------- _ Date Issued --------------------_____ _____ __ __________________ 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 incompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 1 7.-3 : 1 It ` - �'', -- --------------------- ---._CENSUS TRACT --------------........... Owner's Name _J3,5:D.41-----Cu1 d1'Y.17a/------------------------------------------------- ?----------------.--Phone -----------------------------------. -- -_-_ (�- _ f __. Cit Address /�-�-�T --- - ---- _ " - - �Sr--/fll��--------------------- Y�FIf_Y-.�--��------------------------------------•------ 1 Contractor's Name -_ ��...I N-Iz!''___e-_...__._- _______.License A2V39/001___._ Phone ev Installation will serve: Residence ® Apartment House❑ Commercial ❑Trailer Court l❑ Motel ❑Other ----------------------- -------------------- Number of living units:__-_ Number of bedrooms ___„....Garbage Grinder ------------ Lot Size __________________---___-______-------- Water Supply: Public System and name -------------------------------------------------------------------- ------------------------------------------Private RI Character of soil to a depth of 3 feet: Sand j2 Silt 0 Gay ❑ Peat❑ Sandy Loam ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size-----------------------------------.------------ Liquid Depth ___.___-_-_____-__----_- i Capacity ----------------- Type ------------------ - Material---- - --- No. Compartments -------------- J Distance to nearest: Well -_-__________ ____________________ oundation _--__-_-__-____-__-_- Prop. Line -__-_-- --_- - LEACHING LINE [ ] No. of Lines ------------------------ Leng of each I' e-------_--_-___-_-_--___-. Total Length ----------------- .......... t, D' Sox ___._-____ Type Filter Mat rial ___________ _______Depth Filter Material _______...________._____......._,_....._._ Distance to nearest: Well ______ _________________ undation ------------------------ Property Line --------- .............. SEEPAGE PIT [ ] Depth _____-______-__ __ Diam r _____________ __ Number ___ _. Rock Filled Yes ❑ No ,❑ y Water Table Depth -------- -- ------------ -------------------Rock Size -------------------------..----- Distance to nearest: We ------------------L.....................Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# __ _________________________________________ Date -_-_____-_-_-_-_-__-_____-__--_-__) Septic Tank (Specify Requirements) --------- -----------/------- ------------------------------------------------ ---------------------•----,r------------------- -------- Dis oral Field (Specify Requirements) L _'_____ /� -___- ...... �Yf�'--------------------- Of ----------------------------------- --------------- ---------------------- ---------•-- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 Workma 's Compensation laws of California." Signed _______ __ ____ ____�--C"' Owner ----------------------- -- BY - Title - ------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _------------------40v --'------ - - -------------------------------- DATE ------ f----- ------ BUILDING PERMIT ISSUED -------------- ------------------DATE -------------------------------------------- ----------------------------------------------------------------------- ADDITIONALCOMMENTS ----------- ---------------------------------------------- ---------------------------------------------------------------------------------------------------- --------------------------------------- --- ---------------------- --------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- ---- - - ------- ----- ---------------- Final Inspection by: -------- -e--- --•-----------------•- --------------- ---------------------Date -�"' ! + --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 6 E. H. 9 1-'68 Rev. 5M