74-1042 - Laserfiche WebLink

Home Browse Search

�p FOR OFFICE USE: . APPLICATION FOR SANITATION PERMIT ".... - ..1'.......................... . L ..... .. .......... (Complete in Triplicate! Permit No. ...T..— ..'-••_, This Permit Expires 1 Year From Date Issued Date Issued . /.J�-�-�� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described, This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: Own erD NamSeIOCAT#ON c.-W......................... ...:.CENSUS TRACT .......:.:...... p ._. ._.Phone Address Q Ct 1.- . .--. .. t ............... City Contractor's Name ......... '-- Q?'x.. ....Licens�Traller'Court Phone .. ... ... ... �6 d "�607 Installation will serve: Residence Apartment House Commercial Motel ❑Other ..........,-.:..., # 1 _1'7.? 00 X 1;Ve, Number of living units...--/..... Number of bedrooms .-3.....Garbage Grinder ...... --J Lot Size C Water Supply: Public System and name ___-__:...;_,-___-_•-••__ v -----•-•-...-- ---------•-••---•-•--..... :...Pri vate Character of soil to a depth of 3 feet: Sand t Silt. Clay -�❑ y ❑ Peat Cl'( Sdndy Loam Clay Loomt F _. . .-4A as- Hardpan 0, Adobe ❑ Fill Material cif yes, type ............................ .. (Plot plan,..-showing;Aze oG-lot,Jocation-offsystem in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: # i' (No septic tank or s epttge cert permitted if public sewer is available within 2C feet,) PACKAGE TREATMENT ) 1 `I SEPTIC TANK h* Ize... . ------ Liquid Depth _.14.:...... i Capacity I ... _ T e z-_.*Material-- me N Compartments Distance to nearesto- lNeli `°` Foundation Prop. � LEACHING LINE , No, of Lines -------------- Length of each .line.-•-•-------�Q---_----: Total length __-._�................... r 'D'rBox ...-: -.._T . e.tF,iiter„Materiai /4 .._-_ 1 ,t `e YP Depth Filter'Material ..._..-�.. r ...,_.. Distance to nearest: Well ------ Q....r Foundation `) -i- Line----- ..... . ............. Property L'n .-�..�....� - SEEPAGE PIT [� Depth .......... Diameter V t_- - ._ r Number ............I....... ...... Rock Filled Yes ❑ No Water Table �epth " ._. .Rock Size Disfance to nearest: Well -----...................................Foundation ___ --------_--__ Prop. Line'w. ..____..----....... REPAIR/ADDITION(Prev.Sanitation Permit# Date _] Septic Tank (Specify Requirements) ------------------- _-_-__-_.- 1-- Disposal Field (Specify Requirements) ____ ..................................... -..... -.. ..................................... ..................... -- - - - (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local health District.Horne owner or Ilcen- sed agents signature certifies the following: "I certify that in the performance of the work tor which this permit is issu 1 shall not employ 4ny person in such manner as to become subject to Workman's Compensation laws of California." Signed ----------------- - Owner By (I oa.f... ..`th-.an own.-.-. n er) ................................ - -•_..--. Title - ---••<:ZV__t...................... ............................- 111`0R DEPARTMENTkV$E,-ONLY•„,� _-- APPLICATION ACCEPTED BY...... -_---• _�----------------- - •• -•-- BUILDING PERMIT ISSUED --------------------------------------------------------I........... -,DATE ADDITIONAL COMMENTS .....-••••........•••..,-•--••......•----•-•....--••••-----...•----••--•-•--------------- ................................ ...........-•--.............•............... ..................... .... -- --•-------------•---..._ ---•--„-----------•- Final inspection by: - ... _--___., Dat _SAN.JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1-'68 Rev. 5M M _ .