73-588 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: .......x 30 . ...._....... APPLICATIONFoR S-aNITATION PERMIT ` (Complete In Triplicate) Permit No. .73,;,5 ................... This Permit Expires I(Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health D�#riot for a permit to construct and install the work herein described. This application is made in complionceT th—County-<Ord-inon -e-No-.-.i5a4 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..;.....CENSUS_. � . ....CENSUS TRACT Owner's Name ......-.:._ .. ................... .................. Phoneii14' ,3.2t s�7./'.Zj�/ Address ............... ZCit ....._... ......F ---.... ........................ / . Contractor's Name ----.._ . - ,._ U �.�j ..... ... .. . .................... .__._...License #aI�5,3G _ ._ one �....., l Installation will serve: Residence W Apartment House 0 Commercial '[Trailer Court ] I Motel ❑Other ' Number of living units ....... Number of bedrooms __......Garbage Grinder ------------ Lot Size ..�lJG 'Fr -•_ Water Supply: Public System and name ._ ---------=-�-- ----....... Private Character of soil to a depth of 3 feet! Sand ` Vii.Silt❑ Clay ] Peat Sandy Loam M Clay loam C Hardpan ❑_I, Adobe o Fill Material _...__._. If es . Y ,type ................. . {Plot plan, showing size of lot, location of system in relation to 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,) PACKAGE TREATMENT ( ] SEPTIC TANK� 7 sire-----------------•-- ...__...._ Liquid Depth ............ .............•-----...------•-- Capacity..................... F� Type Material______________ No. Compartments Distance to nearest: Well .•Foundation 6 .._.._.-•--•------•-------•--•---- � . Prap. Line LEACHING LINE [ ) No. of Lines .......................• Length of each line.-___...___...____...._..._. Total Length -----__ -• �j ..--...._. Q' Bax Type Filter Material ........Depth Filter'.Nlaterial. I Distance to nearest: Well ......................... Foundation ..................Pi.r [ ) Depth Diameter Number — ................•_-- Rock Filled Yes [] No 4 i; Water Table Depthf :........Rock Size � � � Distance to nearest: Well ................. ........._Foundation ' --•-------••- .................... Prop. line � � PAIR ADDITION(Prev. Sanitation Permit 0 .................................. Date Septic Tanik (Specify Requirements) ...................r--_•,..................•........................... kz � Disposal .Field )Specify Requirements) 1d.. I hereby cern that I ha e: re tired o i g ------:--,-,---- .........--...---••---------------------- ---------------;...---._...._._. t _ (grow existing and required addition•an reverse side) � , �� ; y fy p p' this application the work will'E 'clone in accordance with San' Joaquin i County Ordinances, State Laws, and ',RuleeZiid Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following:7. . _ "I certify that in the perfoymanee of the work for which this permit is issued, I shall not employ any person In such manner g yom; I Workman's-Coatpensation laws of California." /t� Signed ned to ec� s c+f t L........................................` °. ---•--.`� .. Owner . ................ Title (if other than owner) � ............................. .•......_.._. FOR DEPARTMENT USE ONLY E—A TIO_NA CCEPTED BY .......... ...:... ....... . . .. .. BUILDING PERMIT ISSUED r. = ---------------•-- ------......------••-- --•...... .. DATE ..... � ADDITIONAL COMMENTS .. , .............................................................. GATE .................... 1... ............. •-........... ..-.............................................. ................................ •.................... .... ............ --..._.....-•-••--.....-------••------•-• ........ .............---•. _ --.... ........... Final Inspection by: ............... �� .... .,., .--••---------•-----••-•---........- •. ........ •_..Date ..... ." . ......... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24-l-'68 Rev. SMS ,�� .. CTS