75-139 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE., APPLICATION FOR SANITATION PERMIT ............................. ..........I.......... ,. Permit No> (Complete In Triplicate) This Permit Expires 1 Year From Dot*Issued Date Issued ..3.6;75.. 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 ------ - ........................................................CENSUS TRACT ............ ......... Owner's Name ....... /. G �A �.. ...Phone .. Address _.._... oa .......... l� '....._cS.�1iGf.... City ..... Contractor's Name --------•--- ........ - "S -•-----••..............License # �' .. ... Phone .6 g6�7.... Installation will serve: Residence Q Apartment HouseQ Commercial OTrailer_Court 0 r' 1 Motel ❑Other --� ..__ .................... y y ................... pX —o Number of living units:............ Number of bedrooms ............Garbage Grinder :`.:::_..__ Lot Size Water Supply.. Public System and name PP Y= Y ............ ...................----._.......:_ .::.._.._... .. .... ._........... _ .........Private ❑ Character of soil to a depth of 3 feet: Sand Q Silt Q! Clay [) Peat Q Sandy Loam Q Clay Loam Q Hardpan ❑ Adobe "'Fill Materlal ._.......... if yes,type ............................ {jl' S . )Plot plan, showing size of lot, location_of system in relation to wells, buildings, etc. must be placed on reverse side.) 11 NEW INSTALLATION: (No septic tank or seepag—Pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK TSize] ' ' ........:....................................... Liquid Depth .................,.,....... Capacity _ Type ` / t �- Material...................... No. Compartments Distance to nearest: Wel! ..Foundation - -•-•--•-=--------=----• •---•---• ..--•-----=•---....... Prop. Lin® ...................... LEACHING LINE No. of Lines � 3 Z Total Length ] --•----Y�-------------t'Length of each line.---..—:--::................ _..._..................,..,.N a D' Box ---- --..... Type Filter Material ....................Depth Filter Material .........................:.................. Distance to nearest: Well ---•-------------------- Founi3aition :'."'--•-"':•---..... Property Line .........................Z SEEPAGE PIT y Rock Filled Yea Q No Q [ j Depth _....:.._..:-- _---- Diameter ...._-•---...... Number .......................... . Water Table Depth -------------------------------------------------Rock Size -----........---. .............. Distance to nearest: Well ......................... Foundation . - Prop. Line ...................... 0 REPAIR/ADDITION Prev. Sanitation Permit# -----• Date Septic Tank (Specify Re uirements 1 ........ --•- ......... .. .-- Disposal Field (Specify Requirements) __________ _ _ ____________�Q_ -- ...............................•........................................ •--•-•--.._......--•------ --•----•-••-•--•--•.....--•----•-•....._.........------• ........ ................................. ,.;�#(Draw_existing.ono 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: "1 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 War kman's"Compensation laws of California." " Signed .................... ---- ----•-. Owner --------------- ----------- By ..------ Title _...... ' -----•-•------------------- (if.aat than owner) ... ................................•------------------.. + F R DEPARTMENT USE ONLY APPLICATION ACCEPTED =8Y _______ ______ _ ___ ___'___---- -• ----- ................... DATE .. 5. ~ .. BUILDING PERMIT ISSUED ....I............... .......----------_---------------- __DATE ......._ ADDITIONAL COMMENTS ............. ...................... ................ -- ........ ...................... ...._...---•---•-••------•-••---_•.._ ` ..............................................• ................................. _...._..._ y - .....__ '. _.. i final Inspection by: .Date SAN JOAQUiN .LOCAL 'HEALTH DISTRICT E u_ 13 24 2_-s._a nom...... r.ja& _—