74-59 - Laserfiche WebLink

Home Browse Search

FOR OFFECE USE: APPLICATION FOR SANITATION PERMIT 7 �� ---- - -- ---- (Complete in Triplicate) Permit No. ---------- V- -0---------------- This Permit Expires 1 Year From Date Issued , 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 i co pliance with County Ordinance No. 549 and exi ti Rules and Regulations: 4,Zl `f 15 S d r '¢"f " �1 ,, l f ,�w,1/,o/•d�9*'.. 6CA s9 r�N : Zcf7—!�r7 c7� JOB ADDRESS/LOCATION - __e --ll�'�'� �K-------1� -------------------------------CENSUS TRACT ------------- Owner's Name - - rnC ------� �zI --- Phone r.�9-_ 7 Address r ' '` ` ' �lZ�------ -. City .a�-NF1!" -------- ------------------------•-------- Contractor s Name - --.01 .-91I e------------------------------------------License # ---------:-------------- Phone Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court I❑ Motel ❑Other ------ Number of living units:-.-X---- Number of bedrooms _ ---.-.Garbage Grinder ------------ Lot Size "All ___------------- Water Supply: Public System and name ------------- ------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'X Silt El Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) l NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size--- `,1� R� _ .------------ 1 Liquid Depth .T ...._._..... Capacity/,P-0a__._... Type _ Material- _ f._ No. Compartments _'2 ............. V Distance to nearest: Well -__ �_.�....................Foundation --------- --------- Prop. Line _*----_...._..._.._- 11 LEACHING LINE [ ] No. of Lines ......P__.._------- Length of each line-------7P------._.__ Total Length -----3.-��............... '1 D' Box ------------ Type l=ifter Material PV--------------Depth Filter Material _-41 ------------------------------------ F �-� Distance to nearest: Well --- _�....-.._ Foundation _�.p l ................... Property Line ._ -._-.-. ---------- SEEPAGE PIT [ ] Depth -------------------- Diameter ................ Number ..----------.--------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------.------------- Prop. Line ---------..-._._..---. REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------- ------------------ Date ---------------------------------- Septic ...---------.._.-_-_---_.---.-._Septic Tank ISpecify Requirements) ------------------------------------------------------------------------------------------------- ------ I 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 "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 Wo an's Compensation laws of California." Signed - a � - Owner l BY - ------ -- ---------------------------------------- Title -------------------- 11f other than owner) ea FOR DEP TMENT USE ONLY " APPLICATION ACCEPTED BY ------------ DATE 'Gf J ` -- - ------ -------------------------------------------------- BUlLDINGPERMIT ISSUED -------------------------------------------------------------------------- --- ------------=--------------DATE - ----------------------------------------- ADDITIONALCOMMENTS ----- ------------------------------------------------------------------------ ------------------------------------------------------------•------------------- ------------------------------------------------------------------------ ------------------------------ -------------- ------------------------------- -- - -------------------------------------- -- -- -- ------------------------------------------ -------------------------- -- ----------- --------- P Y -- - Date ......... - Final Ins ection b — - �� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M.