74-90 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT / Permit No. ....Z�,f.....r(...... �� (Complete in Triplicate) r� This Permit Expires 1.Year From Date Issued pate Issued .................... Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. T-JOB ADDRESS/LOCATION ,:.... r -----------. .. ..........CENSUS TRACT .........-:........'.:.... Owner's Name ..............' `t �r ... c_c,_. .......Phone , .:�� ...... ----._...... .... ......... ...... Address ................................. -•-----•----•---••---...... ....................... City ---� _57f= w' ........ .................... Contractor's Name .......... � � ......License .... Phone .�.`' . .� Installation will serve: __-Residence I&Apartment House❑ Commercial :❑Trailer.Court 0 k Motel ❑ Other ----......:................................ C 1 - r t Number of living units...1....... Number of bedrooms _...Garbage Grinder ............ LotrSize � ..� .1�................... Water Supply: Public System and name .........��-:Lk44..- Uel?'.cnr` ---•---.-...._...-•................... ..........................Private ❑ ,i t I Character of soil to a depth of 3 fee#: Sand❑ Silt❑ y Clay,.❑ Peat C] Sandy Loarh ❑ Clay Loam ❑ Hardpan ❑ Adobe [5`Fill Material ............ If yes, type ........................ ... i fl {Piot plan, showing size`of lot, location of system in relation ta wells, buildings, etc. must be placed on .reverse side. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} k PACKAGE TREATMENT SEPTIC TANK�J Size.............................I.._............ .. Liquid Depth .......................... CapacityType ...... Material.......... ....... No. Compartments l Distance to nearest: Well ....................................Foundation ...................... Prop. Line ----.................. r LEACHING LINE [.] No. of Lines ......... ........ ..... Length of each line.............______......... Total Length _._ ..................... r f 'D' Box Type Filter Material ..................Depth Filter Material ! .. .J I 1 I Distance to nearest: Well ........................ Foundation ........._ .............. Property Line ....... -._ SEEPAGE PIT [ {: Depth -` ............. Diameter. ................ Number ........... ................ Rock Filled Yes ❑ . No [J Water Table Depth ... Rock Size Distance to nearest: Well -._ ......Foundation .................... Prop Line .............. REPAIR/ADDITION(Prev. Sanitation Permit# --••----------------------- ............. Date ......•---------- ------I....... i ?j SepticTank (Specify Requirements) ................................ ...........................-------'.--------------•......................................................... Disposal.Field (Specify Requirements) •--......... .._. �.. `F� ...... :. --- .................. "_ ' t ..... .....................................................................------------------------- ..................................................._...........................................-.._._. j �; f (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 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 for which this permit is issued, I shall not employ any-person in such manner f as to become subject to Workman's Compensation laws of California." Signed I : . ne - ---•--• ---------------•- `Ow r By .. .... .... - Title . . ..................................................... (If other than owner) -- — r FOR DEPARTMENT'USE O LY APPLICATION ACCEPTED BY ..... .... ................................. DATE ...... '... U:.7.. .... BUILDINGPERMIT ISSUED ................................................ ........................... ------- -----------............DATE _...._.. ........I.......... ..._. ADDITIONAL COMMENTS ........... _ ...............k..........---.......... •---... -_.. . .. ..--.-•-• .. . • --• . ----..----*......... Final Inspection by: Dat l ........ SAN JOAQUI LOCAL EALTH DISTRICT _ F -13 24 i. �R RAv_ SM % 7I72 3 M