73-601 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: 5a APPLICATION I OR SANITATION PERMIT /..._.. 7._�1... . .... Permit No. ../ ..��.��_ �! (Complete in Triplicate) 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION1 .. ..:_.� a........................................ .................CENSUS TRACT .......,.-._..-........... —W*.-.... ._ .__..___. ... Owner's Name ......... ....... -- .....-•---••....... .,........................... e ............................. .---- Phone -. Address City S.Ver/ Z/ ................ Contractor's Name 0.k..--.... u--j r'- ' ,r---------------License # a 7J- Phone �Zl5 ' Aev Installation will serve: Residence ®-Kp—artment House❑ Commercial -'❑Trailer Court i❑ Motel ❑Other ...--•................. ..••--••------•----- / } Number of living units:....)...... Number of bedrooms ..`....,.`}Garbage Grinderf _. Lot Size ....... ......... Water Supply: Public System and name ..........0-96N......•-----kms........•---------_....--•Q---••---------------••------...-............Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt Clay Peat❑ Sandy Loam C] Clay Loam ❑ Hardpan ❑ Adobe Fill Material -1U.12.. 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 sewer is available wifhin 200 feet,) PACKAGE TREATMENT [ ] i bSEEPTIC TANK t Size..... , 1 . ...................... Liquid Depth ..._ _.........._ . . . Capaci .... Typ o-0.02 .. Material -_. No. Compartments Distance to nearest: Well .__../ ............FoundatianlP............... Prop. LineE;7..............� LEACHING LINE of Lines --------------- Length of c�h line.--_.�5}�'�__.__ Total Len th _.�7Q_i........... V1 ` 'D' Sox . Type Filter Material .Depth Filter Material ..' 1 Distanc to nearest: Well .. ,/� . Foundation ..../0Z.......... Property Line _...............O SEEPAGE PIT [Depth Diameter Number ....�? ............... Rock Filled Yes . � 1 rf Water Table Depth ..... G� .........................Rock Size Distance to nearest: Well ._../f�,, _`_________________Foundation .-,LL?l--_----_ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ................................ SepticTank (Specify Requirements) ..............................____.................................................................... ...._-.......................... DisposalField {Specify Requirements) ------------------ ------- -------- ------------------------------------------------------------------------------------------------ ------------ -------•---••----------------------------------------------------•--...------------------------....-- .........._.........................................................-................... ..... t ---..............•....-., -------------------------------------------------- ............... (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 far 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 ---- ............................. .......................................... title �"1..r1-------_-------- (if other than o FOR REP MENT USE ONLY APPLICATION ACCEPTED BY ...... ............. _...__....... ..__.........._.....---....'............ DATE .. �• BUILDING PERMIT ISSUED ............ DATE ...................... ADDITIONAL COMMENTS ..................... ----------------------------------------...............................................................-..............-.......... .. ..._ .. ••- -- ... .....•--- --- ---..-..••---- ---- -- .......... Q .__------------• .................................... ..... --•-••----------•------------------- --- ---- ------- -- Final Inspection by: ... ...... ......................................Dae I ................. .. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1-'68 Rev. 5M 7/72 3 tK