72-76 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FGR SANITATIONPERMIT -------------- _ =- ---------��. ------------ (Complete in Triplicate) Permit No- --.7� ------------- --------------------------------------------------------- 2- / 7 L __ _ _______ -____ This Permit Expires ] Year From Date Issued 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: JOB ADDRESS/LOCATION _cfz__t_____ _L_E _l�_1 T�---------5�------5"t<d------CENSUS TRACT ---------------------_--- Owner's Name _� �,.-- - 54-AID��l-- Phone --r e w '�r Address -------- -------- 14 -----5-7n-------------------•--- City ---------------- ----- Contractor's Name � - --------- - ------.License # �Q-Q �l----- Phone 4_Ob_1l-r-3_1.... Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ;f] 4(0b Motel ❑Other ------------ ------------------------------ Number of living units:__--------- Number of bedrooms y --Garbage Grinder _Lvo___ Lot Size _�o_O__ -� _____________ Water Supply: Public System and name -----�_ -L'--------]/.5.1-A_T_Cf-_Z,, ----------------____--_----____----__---------Private ❑ Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam .❑ Clay Loam ❑ Hardpan ❑ Adobe X Fill Material ------------ If yes, type _________________________ {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW 114STALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200.feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] 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 ----__------- ----_•Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ---------.---------_...- SEEPAGE PIT ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rack filled Yes ❑ No (3 Water Table Depth ------------------------------------------------Rock Size ----- ------------------------- Distance to nearest: Well ----------------------------------------Foundation ------------------- Prop. Line ---------------------- SWAM/AODIVON(Prev. Sanitation Permit# ------- ----------------------------------- Date ---------------------------------- ' X --- --------•---------------••- Septic Tank (Specify Requirements) --------------------- ---------------- -------------------------------- ------- Disposal Field (Specify Requirements) -1-4.-_ ----1 o... AR A1-I1-V-SUM P-------- --------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ------------------------------------------- -------------------------------------------------------------------------- - -- - - ---------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 as to bercome bject fi Workman s C mpensation laws of California." Signed s Owner BY -tib G+ t4- ----------------- Title `� X'-_I-' --- (If other than owner) RTMENT USE ONLY APPLICATION ACCEPTED BY .- -- _-- -- - -------------------------- - DATE _ "_I _ --------------------- BUILDING PERMIT ISSUED ------- ---- - - ---------- --------- ----------------------------- ----------_-DATE ------------------------------------------- ADDITIONAL COMMENTS ------- ---- -------------- - -------------------------------------------------------------------- -- -- ----------------------------------------------------- ----------------------- ------------------------- ------------- ------------------------- ----- Final Ins ection by: _Date . P - =- ------ - SAN J AQUIN COC HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M