74-1077 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .�...�/�' -•--.•.. ...............•-- •-- .-•---._. .... This Permit Expires I Year From Date Issued Date 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 Regulationst JOB ADDRESS/LOCATION .-. ...... .•.------„Gu'..,,..OsG� _-,. ._ .... CENSUS TRACT Owner's Name ... __J. t�i i.h.__..-. !L? S-•.... .. ....................................... . ....... ... ..Phone .. Address °...- ....... _ Ci ..I................... Contractor's Name __ --:•-.--- � '' .•................License # .�Y .7�._ Phone ...� _ Installation will serve: Residence Q Apartment House[] Commercial CITraller Court 0 Motel❑Other---------- •. •---•-••--••-----•----••. �� ',23t/�-�� Number of living units:_-__r.--- Number of bedrooms .._ -•--.Garbage Grinder ............ Lot Size . - Water Supply: Public System and name ......................................................... ” --•---•-----------------------------•-----...... 4�-----•---._..._...---Private c� Character of soil to a depth of 3 feet: Sand'Q Silt Q Clay A Peat❑ Sandy Loam ❑ Clay Loam Q Hardpan p Adobe O 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 ide.)NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKf ] Size.................................................................•--_.. Liquid Depth .......................... Capacity --- ----_- Type ••---•---••••-•--... Material...................... No. Compartments ..................... Distance to nearest: Well ....................................Foundation _-_.._. ............. Prop. Line ..................... LEACHING LINE { j No. of Lines __--------------------- Length of each line............................ Total Length 'D' Box ..... ...... Type Filter Material ....................Depth Filter Material Distance to nearest: Well ........................ Foundation ........................ Pro (�x party Line ........................W; SEEPAGE PIT { ) Depth _.---,-.----_--.-- Diameter ...... ......... Number --------------_-----_- Rock Filled Yes 18' No 0 Water Table Depth ------------------------------------------------Rock Size ........�%................ Distance to nearest: Well ........................................foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ................................. ._.. Date ....... Septic Tan_ k Specify Requirements] .......1 ��d ...... G� D� u G�c Vr ....- // ................ Disposal Field (Specify Requirements) ._.I......... �.�,�1'� --- .................................................. ........................................ .....................--•-------.-- -------------------------------------------- ---- - -------------------------------- ------ ---•-----•---••--•....-- (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. Homo owner or licew 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 :..._ ------------ --- title 9- . �e (If other than owne FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.._. DATE ...//-.j9.7_-_Z4/ --.--- BUILDING PERMIT ISSUED ....._- ------- ------DATE . . .................. ...... ADDITIONAL COMMENTS ....- .._. . .................................. - - ............................ ._-------•---- •-- ........... Final Inspection b - --tr - Y� ------------------------------_...._.._...------ ---------•------•------•---•------ -- _ '` -�".�•-----.._.._.Date .. . :.�:` ---�� EH 13 2h 1-68 Rev. 5M �/C> Y. SAN JOAQUIN LOCAL HEAL DISTRICT 8/71; 3M