75-923 - Laserfiche WebLink

Home Browse Search

' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .�S ......�................................................ (Complete in Triplicate) .......................................... Date Issued This Permit Expires I Year From 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: ]OB ADDRESS/LOC ION ../.. 2... ........................... CENSUS TRACT ................... Owner's Name : '- ,.. _....-..... .-..� ..Phone ..----••... City Q-[�! Address )' -• A �Q . ...... .. y Contractor's Name . ....�� License # '".. Phone ..._.......� _4:,�g. 01 ft Instailotion will serve: Residence d Apartment House f1 Commercial ❑Troller Court 0 1 Motel [3Other ...__.. . -_-. Number of living units:.... ------ Number of bedrooms ............Garbage Grinder ...--------- Lot Size .................. .. ,,/ (�J Water Supply: Public System and name ---------.............................. ..._.- - • -------- ------- .......Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe-C] 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.) f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet°) PACKAGE TREATMENT [ ] SEPTIC TANK Size. r �-�. .��. �............... Liquid Depth .4.----_........--,..... r ` -:.__.. . Material._Ll+'''�--�-�•-• Na. Compartments ...:_r Capacity ��.--•---- Type •--- �'s -------- Mater" to nearest: Well ............. ... ..Foundation ...J-10_1 Prop. Line .... _7........_. —I LEACHING LINE [ J� No. of Lines ---------r-- Lengtfi of each line.------- Total Lenfn gth ...L0.4)............... N . 'D' Box ............ Type Filter Material __..r.�.�Z_ --•Depth Filter Material .. .:. .......... ! 64 d--t.......... Foundation ........�..0.......... Property Line ._..�'..... Distance to nearest: Well ..__ _ _ t SEEPAGE PIT ( � Depth .--26r-.f ..... Diameter • +fit �r 1~iumber ....--.. *—......... ..... hack Filled Yes (� No [] .-.. . . OA Water Table Depth - - ---- hock Size ._ .. .. ...�� .3 ---- I I. � r Distance to nearest: Weil ..._.__...1 �.....................Foundation .._� ..... Prop. Line ...-aL, �._..---.-.---•- ! ' j REPAIR/ADDITION Prev. Sanitation Permit# . Date ..................................) Septic Tank (Specify RequiremerIts) --------------------------.....................................................................................--... .. ....._ i Disposal Field {Specify Requirements) ..-----•......_ --------------••---_-•-.................... -------------------------------------- ..........................................._..............:.......................................................................-..... ! (Draw existing and required addition on reverse side) f 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. Horns 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." fSigned -------------------------------------- Owner ;9; By ................................ _ -.. .. - Title ...�� -------_----................. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .-........ .._^ ................................ - DATE - - - - - -�...------- BUILDING PERMIT ISSUED ... -- DATE..._____-_•_--•-•------ ---------------- ADDITIONAL COMMENTS .. --• • '...... ..._. ....,: ....................... ......... ............................ . ----------- ---------- �!!. --•-•............ ........... ..........................•-••......_ .... •-- .............. i ------ -- ----- --••-------•--------------...-----.........----................... -e------I....... ..... --------------------------•--•--...._----- Date I. ..-. ............. Final Inspection by ------------------------------------------------------ SAN JOAQUIN L LOCAL` HEALTH DISTRICT 7/72 3-M .� 1 4 24 , ire o_.. c�,A