71-1076 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ID-'/-�-------------------------------------------- (Complete in Triplicate) Permit No. _7[710--- `tx 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 ._ Cts- --5! _ C�- �a_ -- --�Uo�-o--�--fel-ir`44_-_f--------CENSUS TRACT -------------------------- Owner's Name ----- ----------------------------------------------------------------------------------------------------------------------------- ------------------------------------Phone ------------------ ----------------- Address ---------------------p--- _� ------•E------- ! ^'------------------•--. City .5_ 16-T -tJ Contractor's Name ----&!k Por- ---------------------------------------------------------License # -- ------------------------------------------------------ Installation will serve: Re'sidence-©'artment House❑ Commercial [-]Trailer Court Motel ❑ Other -------------------------------------------- Number of living units:________ Number of bedrooms ____2-:__Garbage Grinder�r_Ss______ Lot Size�1!uv____-------____--_-__-_- Water Supply: Public System and name _��k-�;. ----W -__.Ss_ ---_--_ ___Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ AdobeFill 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 seepa a pit pe ed if p c sewer is vailable within 200 feet,) [ ] - Si e J �'' i id D t PACKAGE TREATMENT SEPTIC-TAN Capar<ty " Type Mate ial_ _ -_-________ o. C mp tme t -_- _ew Distance to nearest: Well ----------------------------- __e_----- __ __ Prop. Lin / LEACHING LINE [1e'No. of Lines -------1-_____________ Length of each line__ - ____________________ Total Length GGg \ D' Box Nv -__ Type Filter Material __ Depth Filter Material ___la_ ��______.____ ................. ................. Distance to nearest .Well __"_ �`______ Foundation ____ _0_! f - Property Line ---------------- SEEPAGE PIT [?j-' Depth _a.Y-_� Diameter - __:---____ Number ----------1---------------- Rock Filled Yes [ji—No i❑ Water Table Depth --------�-l-_6--------------------------------Rock Size _� 4-_X.�_______-_____- 1: Distance to nearest: Well ._______--"'�--__________________Foundation --I0--� _ --------- Prop. Line -.S77----------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _______________________---________) Z Septic Tank (Specify Requirements) __-____________.- Disposal Field (Specify Requirements) _________________________________ ----------- ------------------------- - - ---- - -------------- -------------------------------------------------------------------------------------------------------------- (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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --- ------------------ ------ Owner -----'-- ----- -- BY - -- - --- 1-1-14-------------------- Title ------------------------------ (If other than o er) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---C_-_ -------------- � r -- -------------------------- ------------------------------------- DATE /V_-� ----- ------------------- BUILDING PERMIT ISSUED ____ _____-___ __ ,< DATE -------------- ---------------------------- -COMMENTS bb `fa l_ - -----: --- ��D = _ _ --.------- _- = 1 C,a.:1 _ _ _ _ • _ -q w ------------------------------------- - - - - -- - - --- ----------------------------------------------------- /s - ------- -- d"� '_ ,a�} ►,__ Lod Final Inspection by: __.___________-- _ ____ --- ate SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M C