73-876 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. 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 applicatiog is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: .. i JOB ADDRESS/LOCATION ..........- w" ..... ... ....... . ....CENSUS TRACT .... . Owner's Name ......./ Y .111 / .......&-r"5......... �.G`_ir'.I"�� ..---- .....Phone Address 7�� Ze� .............. Gty .. �..�.8_. Contractor's Name �_.. . ll! ��?-/(r.'y. y - v![. ..__•- ........License # . �7�6 Phone Installation will serve: Residence ❑Apartment House Commercial IRTrailer Court 0 r ` Motel ❑Other .................... n . Number of living units..---7.77Number of bedrooms :Garbage Grinder .......... Lot Size Water Supply: Public System and name ..................... Private�I Character of soil to a depth of 3 feet: , Sand❑ Silt❑ Clay :❑ Peat[��qq_ Sondy.Loam. Clay Loam ❑ �s Hardpan [] Adobe.f] Fill Material -?fly.. If yes, type ___________________________ {Plot plan, showing size of lot, location of. system I relation to wells, buildings, etc. must be placed on reverse side.] NEW INSTALLATION: (No septic tank or seep pit permitted If public sewer Is available within 200 feet,} ' r PACKAGE TREATMENT j a SEPTIC TANK Size.. Jr.............. Liquid Depth - .................;+f Capacity ./W_l'•'i._..___ Type 1''�_ HS Material.__. C:f No. Compartments .. 0 Distance to nearest: Well ....................................Foundation f./Q.`------------ Prop. Line D© .. p 0 LEACHING LINE No. of lines ___.. .............. Length of each line.._I.01)-`__.___......... Total Length a __yG'' . . r� 4 D' Box .._..��_.. Type Filter Material f..•-! �` rflepth Filter Material ------rc�C_--• ri............................ Distance to nearest: Well ........................ Foundation '_-:.._..____.. Property -Line .. r SEEPAGE PIT [ } Depth .......... .......... Diameter ................ Number ..-------------•----• ------ Rock Filled Yes.❑ No {] Water Table Depth ................................................Rock Size •......---..........-•---..... -c Distance to nearest: Well ..........:.............................Foundation .................... Prop. Line ..._..... ............ REPAIR/ADDITION(Prev. Sanitation Permit# .............................................. Date ................. Septic Tank (Specify Requirements) 1 - ----------- ........... .......................................... -----......_ ----------•-- -- -------• ---------..................7...................... ------.........-••-•...._......••--•--- -- ��`_� . (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. 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 become subject to Workman's Compensation laws of California." Signed _.. Y l._ . 41! ai ------•_ .... By .-- .. Title .. ...._ - -•--------------------------•-•----- ................................................(If other t r} FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY .. �C .-....----•.............. , .................... DATE ..... 7'� ... BUILDING PERMIT ISSUED ------------------..............................................................•.:......._DATE ........................................... ADDITIONAL COMMENTS ------------------------------•- -.._ .._..../�__ : .. -- ....................... ...-•--- _ --....... .............................................. Final Inspects ..:..Date SAN JOAQUIN -LOCM HEALTH DISTRICT E. H.13 24 1.'68_Rev. 5M 7179 3 M