74-556 - Laserfiche WebLink

Home Browse Search

r FOR OFFICE USE: e ; APPLICATION FOR SANITATION PERMIT N0. 7 (Complete in Triplicate) Permit N 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 nn in compliance with County Ordinance No. 549 and existing Rules and Regulations: l JOB ADDRESS/LOCATION -------J l _ `S_t -----BA16 1----� __.?-_&EVL-------------------CENSUS TRACT -------------------------- l Owner's Name -----------�l?w�- R& _F0-------------------------------------- --- Phone Address --------------------------- `61-----N, f 401u--_ �-------------- --------------- City - Svc ----------------------------------------------------- Contractor's Name --------- -----------------------------------------------------------=-------------------- ---- Phone _� S"t--� ----- - __.License # _ SSB ► Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ❑ Motel 2.6ther __(&YW+_ `-.__-_ Number of living units:------------ Number of bedrooms ------------Garbage Grinder _,_______ Lot Size -------------------------------------------- t Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private E] I Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ Hardpan ❑ ` Adobe '❑''Fill Material ----- ------ If yes,type ______-___________________ i (Phot 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 [ ] SEPTII/CCT�T,,A��NK'[ Size------- ---I90-1e)-- - -------------- Liquid Depth __:z= _/_C—__..-____--_- Capacity - 31210- TWell °_C S ___ Material No. Compartments t -----* -- ------------� Distance to nearest: ell --------'�t___________________Foundation _..-_J-O______--___ Prop. Line J . - LEACHING LINE ' [ ] No. of Lines ._`' -------- Length of each line------!10----------------- Total Length -------qC2_______________ 'D' Box _ ---- Type Filter Material _�Ptoc-------- Filter Material -------- p�_`_'_..________--------------- i -_____ Foundation -a___________ Proper Line __ . .. .- Distance to nearest: Well ___'_��___ ----- Property I SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number _______._____._.-.____.__ Rock Filled Yes'n No i❑ i Water Table Depth --------Rock Size ________________________________ Distance to nearest: Well ________________________________________Foundation --------------- ---- Prop. Line _-____-...___---...._. < REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---__.________-_-_-._____...______) p Septic Tank (Specify Requirements) ------------------ ------------------------------------ ----------------------------------------------------------------------------- iDisposal Field (Specify Requirements) ----------------------------•-----------------------------------------------------------=- :--- --------------- i ---------------------------------------------------- ----------------=------------------ -------------------------------------------- - --' ------------------------------------------------------------------------------------------------------------------------- f (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 bec me subject to Workma 's Co pensat' n laws of California." Signed .i � Owner i Title ------------ By. - ----- - --------------------------- - (If other than owner) FOR DEPARTMENT YSE O Y i' ACCEPTED BY --------------------------------------- 022e� ------------- - ---- ------ APPLICATION - DATE ,� `'� J I BUILDING PERMIT ISSUED ------------------------------------------------ ------------ - --DATE ---- ------------------------------------- ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------------------- --- --------_---------------- -- -- ------------------------------------ --- --------- -------------------------------------------------- ------------------------------------------------ ----------- Final Inspection by: ---- = G � ----------------------------------------------------- ---------------------------- --Date 1 44 o SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 . 1-'68 Rev. 5M a�.