71-065 - Laserfiche WebLink

Home Browse Search

U '/OR OFFI E USE: APPLICATION FOR ,5ANITATION PERMIT ' €C =mplete..>ji�Trip'licate) Permit No. _.. ----- ---- r ------------- 1 ________________________ 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/LOCATION -`_-:�'Y- rC ------ -- -- _ -----CENSUS TRACT Owner's Name --- � c--fir/ , w - I------------•- ------------------------------ - -------Phone t Address -------- _47 ------ ----- Cit Contractor's Name ___.__ f.�___-- ------- ----------- License *1 _ Phone Installation will serve: Residence Apartment House'❑ Commercial ❑Trailer Court Motel ❑Other ----- ------------------------------------- Number of living units:_._._':------ Number of bedrooms 1;Z----•_Garbage Grinder,i! f _ Lot Size _-f:, -- -- -----------•- Water Supply: Public System and name __ __V41�----41? �5' r,-------------------- --------------------Private ❑ Character ofoil to a depth of 3 feet: SandEl Silt❑ Clay E] Peat❑ Sandy Laam ❑ Clay Loam ❑ er+ # Hardpan ❑ Adobe ❑ 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: �fNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size__ r � 1?� ------------------ Liquid Depth _� ---------------- Capacity 417-e -----_ Type�� Material_��r!�✓'_- No. Compartments ____________________. 01k. .00 Distance to nearest: Well ----- --------------____________ _Foundation __fp----------- Prop. Line __ LEACHING LINE [ No� Lines ______________ Length of each line--.-'- ------ Total Length P.4------f D' Box ! -Q Type Filter Materia) ___4? ..Depth Filter Material�a---___- ---------------_--,•- Distance to nearest: Well --_ _____- Foundation - v��-�-_-___-___ Property Line. �---------------- SEEPAGE � Q ---- ---------------- SEEPAGE PIT Depths /___ Diameter +_' _ r� Number ___ -______ 5 11--i /' �---- ----------- a s -_ Rock Filled Yes `Nor o Water Table Depth ........ f_s -- -=------------------------Rock Size i Distance-to nearest: Well _______________________________________Foundation __ ._ - -------- Prop. Line .. .............. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------.---------•----------•--_-__) Septic Tank fSpecify Requirei ents) -_____--_. Disposal ---------------- Meld [Specify Requirements) --------------------------------- - - ----------------------------------------------------------------------------------- --------------------i--------- ------------------------I-------------- - ----------------- -----------------------.--------------------- ---.- --- - -- - air -- a - ------------------------------- - --- --- (Draw existing and required addition on reverse side) s I hereby, certify that I have prepared this application and that the work will be done in accordance with San Joaqui�s County Ordinances, State Laws, and Rules and Regulations of the Son 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, I shall not employ any,person in such manner as to become subject to Workman's Compensation laws of California." •� SignedOwner =— _- - _ By - ------------------------------------ � Title - - 1_ 4p 1-- ------------------------- (If other #h w°ner) FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED By -._ DATES-, f------ BUILDING PERMIT ISSUED .--.-I--_____------- ----------- �.- -------------DATE'- - - - ------------------------------------ ------- ' ---------------------------------------- ADDITIONAL COMMENTS _. ' ._ _ -_ _--_---_r_ __ _ ---------�� ? --- -- ----------------- ------------------- ---- ------------------------------------------------------------------ ----------------------------------- ------ -------------------- ------------------------------------- ------ Final !ns ---- ---------------------------------------------------------------------- ------------------------------------------•------ Inspection b p Y� - ------ _ ----- - - -- - �. - ----- ---Date ---- -- J AQUIN LOCAL HEALTH DISTRICT E. H. 1-'6�8`Rev. 5Mi"`t ► C1 t�