75-13 - Laserfiche WebLink

Home Browse Search

i = # FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ��/3 (Complete in Triplicate) Permit No. .... - •---•- This Permit Expires 1 Year From Date Issued . Date Issued Z ...�5 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein 1 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS LOCA ION ...5-.�`!!,AV...... .. / � ��,>��.... .........................CENSUS TRACT .......................... Owner's Name ._ . . . . ....... . ........ ... - --•------•- .............:. __Phone . Address .------IFIR._PA.�... -� -� t ..-----•---•--. City ..... �.............................. . Contractor's Name ..... .._... ... `:.. .. ......._-. ........-License # 1��'.�.f�°-. Phone .............................. Instalfation will serve: Residence U50Aportment House Commercial oTrailer Court 0 Motel ❑Other ----------------- ................... zNumber of living units:...... Number of bedrooms ......Garbage Grinder ............ Lot Size .. ............... ..., -_--...._-.: Water Supply: Public System and name ..............................M...........----------._.......................................................Private Character of soil to a depth of 3 feet: Sand[] . .ilt❑ Clay 0 ' Peat 0 'Sandy Loam fl Cloy Loam 0 , Hardpan 01" Adobe '0 Fill Material ............ If yes, type ................I......... .. (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 seepgge pit permittedfpublic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size...._-.,P...eY.r�.-- d!-- ............. Liquid Depth JF1..................... Capacity �appG-.. . Type . .... Material 4.-�-..... No. Compartments ..?r'............... N Distance to ne rest: Well .._...,d�'O........................Foundation ..�A!..__._.._... Prop. Line .-. --�........... O LEACHING LINE [ No. of Lines ...�--------= ?d�?------- Length of each line---- Total length 1a-.�:.....:......... d 'D' Box .../........ Type Filter.IMoteria) ed,-.R.......Depth Filter Material ... .....................:............ Distance to nearest: Well —.&..`............ Foundation .....1L1..�._..... Property Line .S'_-�... :......... . SEEPAGE PIT [ Depth .....cP .... Diameter -_ .,3.a.... Number ......2--Z................ Rock Filled Yes No 0 i Water Table Depth ...............?.o..........................Rock Size .... l/P.. ........ i 1 Distance to nearest: Wel( ...........IA4P....................Foundation 0.......... Prop. Line .5.-_............. L/ k REPAIR/ADDITION(Prev. Sanitation Permit ............................................ Date ' Septic Tank (Specify Requirements) ......................................................•.....................ti_.—.......................... +- Disposal Field (Specify Requirements) -------------------- ................ •------------------- --.....--•--------------..........------------------....._......-- ------------------- ...............................I.................................. ...-----------...................................----_.._..._...------------------------. ......................................... .........—......................... ...........•...................... ..............................................................................................,.... ............ (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 per 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 ......:.. .... .. Title ................. _ ................. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ......... .................................... ------------------................... DATE ....� '_. �.. `(.......---•-- BUILDING PERMIT ISSUED .........................•--------.............. DATE _.._.........._...._........_.............. ADDITIONAL COMMENTS .............................I....... ................... ...._.._............._....._...... ty ...............................................:. Final Inspection by: --•-------------- ------e ..: ............................................................ .................................... ......................--- .....1.....Date . r ... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 3-3 24 1_'68 Rev. 5M 7177 3.M