71-737 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------ (Complete in Triplicate) Permit No: ------- This Permit Expires i Year From Date Issued Date Issued _S_-�_Q__7-•� r 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 in complia a with County Ordinance No. 549 and existing Rules and Regulations: A JOB ADDRESS/LOCA I Nf---/�A -- Z i --- --- ---------------- ------------------- -,.CENSUS TRACT - - -- Owner's Name _-_ -_C�zb-- --------------- --------- ------ P hon ---- ----- _-- C't i Y Address , NIP Contractor's Name �_ G_-_ �. ---License # ` __ 6 _ { ti --'•-installation-wiil-serve:--Residenc �4partment-House--[5---ommereial: Trailer-C-ourt-;E I Motel []Other ________Number of livingunits:___-- ______ Number of bedrooms _ _ l �+ Garbage Grinder Lot Size I ---- Water Supply: Public System and name ___-_ _ --------- ___Private+ --------------------------- Character of soil to 'a depth of 3 feet: Sand' Silt Clay ! T ❑ y ❑ Peat ❑ Sandy Loam ❑ Clay Loam " Hardpan ❑ Adobe�Fill Material ------------ If yes, type ---------------------------- ' (Plot pian, shawingfs ze of lot, location of systei��ira relation to wells;,buildings, etc. must be placed on reverse side.) (� ; NEW INSTALLATION: {No septic tank or seepage pi't'-permitted if publics er,is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK [ Size_____________________ __----- Liquid Depth ----------------------- -------------------- Capacity- ---------------- Type =- --------- ------ Material---------------------- No. Compartments ---------•- • -• - Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line __...------------- -7 --------__ _ LEACHING LINE [ ) No. of Line - -_- �" + - , cLengt o each Zine------------ -----'-------- Total Length -----------•----------------- 'D' ` Box __j___ Type Filter Material ____________________Depth Filter Material _________-_ k.Distance-to-4i Barest: Well _______________ ______ Foundation _------_____i property Eine -------- .... SEEPAGE PIT [ ] Depth ---------it---_---- Diameter ---------------- Number _ ----____-- Rock Filled Yes ❑ No i❑ ------------ Water Tableepth -------------- - ------Rock Size ----i --- ----------------------- Distance to nearest: Well ____________________________________-.Foundation =1 ,-----------_��-'~Prop: Line -------=------•------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------____ ) i Ses#tic Tank (Specify Requirements)x ein-t-=s-l- ------------------'f-'-�------- o y ` ... Di sal Field (Specify Re uirem 2 t � -� y � ---- - - --- -------------------------------------- -- = r�} (Draw existing and required addition on reverse sidi).; I hereby certify that I_have prepared this application and that the work will be Bone n Gordan"ce with San Joaquin ; County Ordinances, State laws, and;Rules and Regulations of the San Joaquin Local Health Distrlct. H mo a owner or licen-" sed agents signature certifies the following: - "I certify that in,the performance of'the workfor which this permit is issued, I shall not employ any person in such manner , as toibecome,subiect to Workman's Compensation laws of California." Signe- i ned *. By 1eyam?'' r [If other than,owner) f , .`� FOR DEPARTMENT USE ONLY- APPLIiCATION ACCE=PTED BY _-:_ `" - r ---------------------------------------- -------------------------------------------- DATE ---- -ID`_`3.1----e------------- BUILDING PERMIT ISSUED -- ----__ �--- ------------------ "I _ ADDITIONAL COMMENTS___- - --_ ----------- --------------DATE =-.=-.,.- e�'" � r- ------------ ----------------------------- 4 --------- - -� �? T f ---------------- - - - --- --- ------ -- -„-r-- -- - -- -- --- -------- QQ / ` spec#iori by: 1 "•Date ate,---. --------------- SAN Final il �-� 5 i SAN JOAQUIN LOCAL HEALTH DISTRICT ` C E. H. 9 1-'68 Rev. SM _i �y ....--.��,....,..a.. -..�-..-.W.).,,.-<__� -----�--_-__-�-_ Y ---•