75-39 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ................................... f APPLICATION FOR SANITATION PERlWIT (Complete in Triplicates Permit Na. .............................. .... .._.... Yhis Permit Expires I 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 nvgde in cogWiance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .... VfN .;:...... .� ....................... Name !(J'�• 3 CENSUS TRACT ............... Owner's ........... h-------------•--........._....._....__.Pone . ... .........�.��•--.... Address -.. A o�- ....SQ,...._,C)�PO.. ��T•.............. tI ,. city 67%:=15:742Al............: Contractor's Name J&,,6 .....,S—7 77x . ... ............... License #I � •-- Phone f! y .z ._..... Installation will serve: Residence Apartment House Commercial ❑Trailer Court j_] I -- - -- Motel I]-Other .............. Number of living units:.._ ...... Number of bedrooms -......Garbage Grinder -M.0.. Lot Size .. s_` 77 i ........... Water Supply: Public§Xstem and name .................'__.__. ._ ---•---------------•-•-••-•---•-••-----.. .- Private ❑Character of soil to a depth of 3 feet.. . Sand❑ Silt❑ -Clay ❑ Peat[] ' Sandy Loam fl Clay Loam ❑ Hardpan❑ Adobe Q� Fill Material .-.---.._--- If yes,type ......................... (Plot pian, showing size of lot, location of. system in relation.'to wells, buildings, etc. must be placed on reverse side.) 4 NEW INSTALLATION- (No septic tank. or seepage pit permitted if public sewer is available within 200 feet,] . 1 PACKAGE TREATMENT (.] SEPTIC TANK 1" � Size---�,��-�`-•��,�•-•..-..-•------- Liquid Depth Capacity � ala.__.._. TYpeA% Materiai�l/�� No. Compartments , Distance to nearest.• Well � - ••--........:.• N ............................F`ndation .149......--------• Prop. Line�-r... LEACHING_ LINE No. of Lines Length of each line-- -�Q`-------------- Total Length- � . '.D' BOX 'VO...... Type Filter Material 44! ........Depth Filter Material .._�9��. ...........................6 C Distance to nearest: Well .~~.__... Foundation ........ . Property Line -S'.r--..---••-•--•.-• PIT i Si:EPAGE_ Depth ...... Diameter ir '. -,.-dumber .......�........ .......... Rock Filled Yes j�] No i❑ Water Table Depth -,Y ............... .....I........Rock Size -.--•-- i Distance to nearest: Well 7�: .................. Foundation A9.'........... Prop. Line . ............... F = � REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .....___._...- __•--._••____j - { Septic Tank (Specify Requirements) -------------------------- Disposal Field (Specify Requirements) ' ---------------- - ............. ........... ---------- ----- --------------- t (Draw existing and required addition on reverse side) 1 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. Nome owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for-whi'c'h this permit is issued, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." i Signed .... -••------------- •------- ---..... ---- Owner BY ............. .......... ..._.. Title ..C:, i! 4 � ..• - (If other than own ............ FOR DEpARTME T USE ONLY APPLICATION ACCEPTED BY t DATE _..�.:-. :_ _ `1 I BUILDING PERMIT ISSUED A ADDITIONAL COMMENTS � "� � % DTE i ...... _ ..rs _.....1� . - ••.. ...........•--...--•• . . •--••-----•..............•------- _ ...... .......•------... --•••----•--..........._....._. Final Inspection by: . e x} ................................ .......... •---..... ....---.............Date . -r1, .........I� -•._ _ Y SAN JO QUIN LOCAL HEALTH DISTRICT E, H. 13 24 1•'68 Rev. 5M 7/72 3 M