73-202 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 2_ � O APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- - Permit No. _�3 �-_- Y (Complete in Triplicate) Date Issued- a��/�7,23 ----------_. '-------------_----- 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 . L'Dt2 _. ---- ----- --Phone ------------ ----------------- p Address ------�Qe. .....__15 4t1 ------------------------------ City go-_Z7 9le_ Cont actors Name .. .... __ C,cc.c-------- e_______.License # _,,Z�4 _3_ Phone _401 _ 45-d,-�e Installation will serve: Residence ❑Apartment House❑ Co` rcial14frailer Court ;[] Motel.❑Other - Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size __41 _- 1 t Water Supply: Public System and name ----------------------------------------------------- --------------------------------------------------------Private ,,( Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat, Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe-E] Fill Material --------- If yes, type -------------------- - W (Plot plan, showing size of lot, location of system in relation tcr wells, buildings, etc. must be placed on reverse side.) o p NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) k PACKAGE TREATMENT { ] SEPTIC TANK [ ] Size------------------------------------------------- Liquid Depth ___-___-___--__-___,_____ Capacity -------------------- Type -------------------- Material-- --------------- - No. Compartments ---------_-_------ Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ...................... LEACHING LINE [ ] No. of Lin ,s ______/______________ Length of each line—:'P-)e4_0--------- Total Lengtfe,_� 0_. ,�, 'D' Box Type Filter Material _f�__4" - Depth Filter Material .._ -------------------------•----_- 01 76 Distance to nearest: Well ____ Foundation _._ Q__ __._____ Property Line _ -----_---_--__ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line ---------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ---------- ------------------------------- F le Dis al Field (Specify R quirements) _ ---------- ._X_ ......... ___ L--___.r 4 j . / 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 signature certifies the following: f "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 s o Workman's Cp pensatron laws of California. Signed --- ---- -------- --- Owner By ------- -------- -- Title ---------- ----------- ------ ---- -------- - ------------------------- 1 (If other than o ner) " FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- % ------------- ---------------------------------------------------------- DATE �r ? ------------------- BUILDING PERMIT ISSUED ------- --- -- -- _--------------------------------------------------------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS ------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- -- ---- Final Inspection by: -----------�` Date / -3---- - -- ------------ - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M