74-220 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: } APPLICATION FOR SANITATION PERMIT -------------- -------- (Complete in Triplicate) Permit No. __7___ _----}'_O ---------------------- This Permit Expires 1 Year From Date Issued 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/LON �`� �2 ----------------------------- - •- ---------------- -------- --.-CENSUS TRACT -------------- ---------- iO�CA�T,I� ._ ______l =' - Owner's Name1 C� _ Phone ------------------------------------------------------ ----------------- Addres - d city Contractor's Name __ ________� �/ ---------------------------License # Y, s�� Phone Installation will serve: Residence [�] Apartment House-E] Commercial OTrailer Court Motel ❑Other _.------------------------------------------ Number of living units:_.__ Number of bedrooms __L,:7----Garbage Grinder ------------ Lot Size ��' ' Z —____-----___ Water Supply: Public System and name ---------------------------------•------------------------------------------------------------------------ -__Private (g Character of soil to a depth of 3 feet: Sand r Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material __________ If yes,type _________________________ Plot Ian showing size of lot location of system in relation to wells buildings, etc. must be laced on reverse side.) ( P 9 Y g , P NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size____________ ______________________ ___ ____ Liquid Depth ------------------------_ Capacity -------------------- Type -------------------- M erial----------------- ---- No. Compartments ...................... uJ Distance to nearest: Well ___________________ -------_-----Foundat' n _____________________ Prop. Line -_--______._.__ ...... LEACHING LINE [ ] No. of Lines ____ ------------------- Length each line_______ ------------------- Total Length ,____-___------.._.___-_--- 'D' Box ------------ Type Filter Mate 'al --------------------D th Filter Material ________________________•--_•.--___•--...._ Distance to nearest: Well ______ --- `----------- Found ion ------------------------ Property Line -------._._____--.----- SEEPAGE PIT [ J Depth ___________________ Diam er _______________ Nu er _________________________ Rock Filled Yes ❑ No i❑ -� , Water Table Depth ----- ------------------------------ ----------Rock Size -------------------------------- t� Distance to nearest: ell ________________________ ______________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prey. Sanitation Permi ___________________________ ________________ Date ----------------------------------) Septic Tank (Specify Requirements) ------------ ---- ----------------------•- --------------------------- Disposal Field (,Specify Requirements) _•-- _ ____-_ f_____________________ --- =� 'C/ c��' f x ��/ ,� �� J`l_-�'7/ -- ----`------1�-- -t--w—S5Z—'_—___e ..... - ----------------------------------------------------------------------------------- -------------------------------------------------------------------- (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: "1 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 subject tc Workm 's Compensation laws of California." Signed /� - --- - ---- ------ ---- Owner ( C _ r' - - Title (If other than owner) OR DEPARTMENT USE O Y I APPLICATION ACCEPTED BY ------- < --------------------------------------------- DATE v `Z'U a� -------_ BUILDING PERMIT ISSUED ------------------------------------------------------------------ --------------DATE --- ----. ------------------------ ADDITIONALCOMMENTS ----------------------------------------------------------------------------------- ---=------- -------------------------------------- ------------- --- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------" ---------------------------------------------- ----- ---- - ------- Final Inspection by: ---------------/--- - Date - -- 1-_�, SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M