74-573 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT .............• ------ (Complete in Triplicate) Permit Na. .. _-- •- -•---_--_-- ..............� �.._ ..:..--- This Permit Expires 1 Year From Date Issued Date Issued . - _ Application is hereby made to the Son 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/LOCAT °......./_./�. ...._ .{._..... .�?.._........�f .._ ....... ACT .......................... } -�" J S T Owner's Name - r ,� /-�- �� ................ .............................Y........••-..._:.._..................Phone Address .....................�� ..p.....�`�. �...... .......................... City ....S, 4-�✓ ----- 0e4ig�.....��, (0 � ........... uu Contractor's Name ...............80 7/"Q-.. Gz ..----_..License # . /.,�3_�. Phone .1..��:':Z,f�-.l.(� 7... Installation will serve: Residence Q2-Ap-ortment House 0 Commercial ❑Trailer Court 0 Motel ❑Other ............................................ Number of living units:.....1----- Number of bedrooms ... 7�.�Garbage Grinder .u.&i_ lot Siz��}4as..&.A.:r�� Water Supply: Public System and name -------------------------------•-•-...---------------.__-.-_-•----_.--_ Pn to ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Cloy Loam ❑ Hardpan ❑ Adobe a I Material . 1.�-- 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 INSTALLATION: (No septic tank or seepage pit ermitted if public sewer is available within 200 feet,) PACKAGE 'TREATMENT [ ] SEOTIC TANK IAA- Size.....,.. ,�Ca� �J.................. Liquid Depth ..flf/�...... Capacity .... Type ��e LJIo!l llliateriai. o. Compartments ---2�_-_--__ tante to nearest: Well .•-:... ....Foundation ..../.Z2._I...... Prop. Line _.. �_....-._.--Z M.I LEACHING LINT? [ Y No. of Lines ......./.............. Length of each line- --------- Total Length oe/ 'D' Box Rl_ _-_ Type Filter Material As!+T Depth Filter Material ..., d ................................... Distance to nearest: Well ..I.V. ......... Foundation ....... Property Line s.................. O r SEEPAGE PIT Depth'._.__.__ Diamete r plumber /............. Rock Filled Yes [Zk---N-o i❑ Water .Table Depth �! .�!----._-_ �..............................Rock Size p c � - C Distance to nearest: Well ....Foundation � � ProP. Line . i .........i/ I REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .............................. Septic Tank (Specify Requirements) --------------------- ............................................. -------- --------------------------------------............ 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 San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Nome owner or licen- 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 • .ur - Title :. ....---•-..,,..-... ( her than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTER BY �� DATE ..... �..d2-..h. ......_-_-_•--•. . .. --------- •..... .........:.._...............---•-•-•--•-.... BUILDING PERMIT ISSUED .,........... = ..............DATE ----_----_-,..,_._... -•-•----•-----•---• ADDITIONAL COMMENTS ........._ rx. -.... ...__---.--•-.--..._--•---•--•-._.... :a`'�'' 'Fr f arra_.. ..-: :-: :: .:::::::::: Date 7- Final Inspection by: -•-• . SAN JOAQUIN -LOCAL HEALTH DIST F. K 13 24 t.,ea R..._ SM 7/72 3-M