73-958 - Laserfiche WebLink

Home Browse Search

t FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .7.3. .:.. (Complete In Triplicate) r�....... ............................................... ... - 7`3 .................................... -------------- This Permit Expires I Year From Dote Issued Date Issued i 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/LO ION p . w� .._ �J_,.4,4...... "'' .....CENSUS TRACT ��........:....:::.:.. Owner's Name' �.� : n .. ........... . ....'__,.,..Phone ......•--•..__... . .... ....... - -- .... .. Address ........... .z. ... .. . ._ City --- .......................... ................_ ............. _. _.. .. Contractor's Name ... 4 {�"'� .License.# ;L _:::'Phone'.............................. Installation will serve: . Residence [ Apartment House❑ Commercial❑Trailer Court {] - Motel ❑Other ..........r:... .......................... Number of living units:.......... Number of bedrooms,_...s�..-Garbage Grinder ............ lot Size .........................-...._.. ........ kWater Supply: Public System and name ...........:.... . ............... -: -..._.. --... ....Private Character of soil to a depth of 3 feet: Sand❑ Silt[] Clay [3 Peat[) Sandy Loam 0 Clay Loam ❑ Hardpan " Adobe [] Fill Material ............ If yes,type --------------------------•- (Plot plan, showing size of lot, location. of,•systeni in relation to wells, buildings, etc. must be placed on reverse side.{ NEW INSTALLATION: ' (No septic:tonk or seepage pit permitted if public sewer is available within 200 feet,), PACKAGE TREATMENT [ ] SEPTIC TANK Size 1�._x _X._ ................. Liquid Depth -.... :...-- W • i ........ ----- . � �� F ndation .A..�_0... ......:..pPro . Lin 3..........:..:.11t Capacity _r�....f�.. Type Material-_ +�f�^-t-_. No. Compartments Distance to nearest. Well ,-.------ P. ....=.•----•.- ou p , LEACHING LINE [�/_No. of Lines.__:._.___.�.._r.... E.. Length of each line...:....- __ Total length __.15Q. ............. D`'Box " . T e Filter Material C}1 _...:_.D6pth`Filter Material .______�4. . ._.'',.: J 4 1 Z Distance-to nearest:-Well _....-r`? :.... Foundation .-- P._ ------: Property Line .+...... ............... �� .Number _..___ Rock Filled .`Yes No SEEPAGE PIT [ Depth . .__ . _:. Diameter °•--y.:..:.:. .�.�----:- ❑ Water Table Depth .., �.� ..... . ..,._....Rock Size Distance to nearest: Well ........�:.._-• -----:_--. 31 ..Foundation' Prop line . -j---• - j REPAIR/ADDITION(Prev. Sanitation Permit# ........... •-.- ::.......---- Date'..:.....:....:..................) - Septic Tank (S ecifY Requirements).-..., ` ..............`------------•--.--------- ..-..---.-.-- Disposal Field (Specify Requirements) ..............................................•-•--••--------•-------...--••-----....-•-•----------------•-•---...._.. ......_..-------- ............................. .........- -----------------•-• -----•-------------------•-•---•---------- (Draw existingand req uired addition ion reverse side) I hereby certify that I have prepared this application and that the work••will be done in accordance will+ San Joaquin CCounty Ordinances, Slate laws, and Rules"and Regulations of the San Joaquin Local Health District,.HoMe owner or Ilten- 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 Work - n's Compensation laws of California." Signed ........................... = ............ - == = = --- •- . caner O ` By ................ }. -••_.. .Title ............ . . c!�....---.......... . -•----..._.....--•-.. (if other than owner) FOR DEPARTMENT USE ONLY .- -• DATE /a- APPLICATION ACCEPTED BY 7 BUILDINGPERMIT ISSUED ..__------—-------f----------------- ........................................... ..........................DATE ............................................ ADDITIONAL COMMENTS . .•-------=- ....................................................-... .................... ............... .. .......... . ... .. ............... -•---•-----:....... -- .................................__........................a'.--..._....._.. ...............:..........................:......... --:..... ..••----.. ...... ........----._'----••------------..__..................------ -----------.-.--------•-- ----------....... Final Inspection by: % a .. • .........................-...................................Dateal!-'r!d ........•... = ! SAN JOAQUIN LOCAL' HEALTH DISTRICT E. H. 1,3 241-'68 Rev. 5M 7172 3 ;4