73-421 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: to"N e-111t d .PPLICATION FOR SANITATION PES._ 0 ................... Y Permit No. . ... 3p (Complete in Triplicate) _._11 .A..................................... This Permit Expires I Year From Data Issued Date Issued .5 -:. .::.-25 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 ith County Ordinance No. 549 and existing Rules. and Regulations: JOB ADDRESS/(.00ATiON ,. CENSUS TRACT ................... ``�� ........ a. Owner's Name .......... . . . . 7_:.._.._ -�'•-•--••---•---........I.....-----•..... Phone ..._..... ...... 7...... ---- ��` Address ........................ . .. ... _ __ `?... ........... City -- ...................................... Contractor's Name •---- ................... -----•- .... ....... -----------License # .7..,7 ._--. Phone .._T ... �.... Installation will serve: Residence Apartment House 0 Commercial ❑Trailer Court ❑ Motel ❑Other ---•........................................ Number of living units:.....l..... Number of bedrooms ...3.....Garbage Grinder ....._..__.. Lot Size ....../_....��.�.............. Water Supply. Public System and name ..................._.. ......................Private Character of soil to a depth of 3 feet: Sand p Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Cloy Loam ❑ Hardpan ❑ Adobe`Ri Fill Material .....__-_-.. If yes,type ........................... (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) (tet NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTICTANK.[ ] Size................................................ Liquid Depth .......................... Capacity ----•-----•-_----- Type .................... Material_--•----------...... No. Compartments ...................... Distance to nearest: Well ....................................Foundation ... Prop. Line LEACHING LINE [ ] No. of Lines ........................ Length of each line............................ Total Length ............................ D' Box Type Filter Material ....................Depth Filter Material ___..... .................................. \ Distance to nearest: Well ........................ Foundation _-__-_..__..__ ..... Property Line -_- .................... SEEPAGE PIT [ l Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No ❑ Water Table Depth -------------------- ............................Rock Size ................................ Distance to nearest: Well ..................................... Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) Septic Tank (Specify Requirements) ..................... ------- --------- ----------- - ------ ................ .... -----•.--••--•--•--.................. Disposal Field (Specify Requirements) ----------- ....... �.- �_..._.. . ----- �.. .y1c- _ - 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. Horne 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." Signed ---------------------------------- --------- --- Owner ,, �}- By .......... ......... .. .. _ .._ . . . -• - --••------------------------._... Title ..G1lf••-'.........................•--------...------------ (If old th wner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. . ................................. •--......_............._..... 13. ..... ... ....... DATE .__Jr_. ..'�.1. ----... ..... .............. BUILDINGPERMIT ISSUED --- ................................... ........................................................DATE -----•------••--•--- ...................... ADDITIONAL COMMENTS -•--_•..................:........... : ------ .::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::: --- ---••----•-•................... ...------. .................----. •. / ........ Fina I nspection by: ---- -----------------•------- .......Dote-..4 .. f _---•-- SAN'.JOAQUIN LOCAL HEALTH DISTRICT �tv. E. H.13 241-'b8 Rev. 5M 7/72 3 ,4---�,