72-598 - 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 6---z_: Application is,hereby_made to the San aquin Local Health District for a permit to construct and install the work herein described. This applicdtion is made in co pliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._. ------�- ------ CENSUS TRACT --•-------------- --------- ��` i ------------------:--- Owner Name Tc/� / ==� � -------- ---------Phone Address _ ir7 'L�.-- ' �/Zt--•--. City / 7-- _ _ Contractor's Name - � e%&- ---------------------------------License #� .-- ✓ Phone _- /Cg Installation will serve: ResidenceXApartment House-[] Commercial :❑Trailer Court ;❑ _ S Motel ❑Other Number of living units.---/---- Number of bedrooms _ _____Garbage Grinder�/�-__. Lot SIZE f��_,k_ �/ - ---------------------- Water Supply: Public System and name -----------_\._________ __ Private ) - -------------------------------------------------------------------- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay [-] Peat E] Sandy Loom -E] m Clay Loa ;❑ Hardpan ❑ Adobex Fill Material ------------ 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 permitted if public is available within 200 feet,) PACKAGE TREATMENT � {,V [ ] SEPTIC TANK' Size�� - ��--��------------- -- Liquid Depth =--�-- ---------------- CapacityIIA"Fl_O ___,__ Type1'Material_ /1f�� No. Compartments Distance to nearest: Wel! __ Foundation _� s ----------------- ----- --�--------- Pro Line . LEACHING LINE No. of Lines __2---------------- Length of each line.__ ------------ Total Length 1_��____-- f ----•-- `D' Box -t-�-_ Type Filter Material _ �� }epth Filter Material Distan a to nearest: Well -__ Foundation _' _� � � - - �� - ---------- Property Line -�.-•----•--••-•--- SEEPAGE PIT De fih ,,�_._ __ . Diameter. -- k Rock Filled Ye No p Number_ Water Table Depth ----fs �___- __ 09 ----•-----------------Rock Size /._-__--r-�--------- -- x Distance to nearest: Wellr___--_-_- -_-Foundation �f �- ---- ------- Prop. Line -------------�'_•-•- REPAIR/ADDITION(Prev. Sanitation Permit# ___________ ---- Date ------------------ -•---'---__-_-} t �, Septic Tank (Specify Requirements) -__.__--_______ �- -------------- Disposal Field (Specify Requirements) ____________ = 4 --------------------------------- f- ; ---------------------- -------------------- (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 accorclance"-with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San,Joaquin-,L'ocall Health District. Home owner or l(cerr- sed agents signature certifies the foil 'wing: �' ' ' .r r.w z 1 "I certify that in the performance of the work for which this permit is sued, I shall not employ any person in such manner as`to become subject to Workman's Compensation laws of California." Signced -- --------------- B 7_ ------ --------------------------- Owner:.er Titley. l �/�C�f J` Y s (Ifo r than owner) r ---- ------ ' DEPARTMENT USE ONLY ,, APPLICATION ACCEPTED BY ...... _ -- -------------------------------. DATE ---- _-:."� — ---------------------- ---------PERMIT ISSUED ____-__- � - -- -- - --- - ---- '--- -------�------------ - -------�`-.�' DATE -------- ----- - ------- ITIONAL, COMMENTS _- _. --------- --------- ---------- -------=--------------------------- --------------------------------------------- ---------------------------------------------------------------------- - ---------------------------------------------- ------------ - ------------------------------------------------ ------------------------------------------- ' _____________________________________ ____ _ 0 ______ _ _ __ ._ ___________________________________.--___-_________.__---_.__---_____--_-______________--___-_______ Final Inspection by: ---- --- -- - - - ---------Date -- ----_ :". - -------- SA JOAQUIN--LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M ,_ , y