72-595 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a �9 1 . I I Z% Permit No. ------- --------- -------=--------------- ------------- (Complete in Triplicate) ------ Issued ---------- This --------------------------------- Permit Expires 1 Year From Date Issued Application is hereby made tc thXSan 'oaquin Local Health District for a permit to construct and install the work herein described. This a plicationad in compliance with County Ordinance No. 549 and existing Rules and Regulations- JOB k JOB ADDRESS PAT!1ION _/_�-o✓t..... � �' CENSUS TRACT IPOwner's Name �.1.___�oQ_�._Gf_�-��------- ------------------ -- - --------Phone --------------------------- --- ---- --• City '�_. Address -- Contractor's + Name _- �_ - - ------ Q-n_6-�rc_i-1 a-h--------------------License # _a-3:37_ a_ Phone Installation will serve: Residence ® Apartment House❑ Commercial ❑Trailer Court ❑ ° Motel ❑ Other ----------- ------------------------------- Number of living units:-----[------ Number of bedrooms ___d�--Garbage Grinder _- Lot Size _______ __. ----------------- Water ---- _ _ .--- . Peat Sand LoamPrivate ❑ Water Supply: Public System and name --------------------------------- --------------------------------------------------------------- Cla Loam Character of soil to a depth of 3 feet: Sand'0 Silt❑ Clay ❑ Y ❑ Y ❑ Hardpan ❑ Adobe ❑ 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 INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 4-44 _ -• Liquid Depth --------------- SEPTIC T`ANK Sizwe�_T_�_PACKAGTREATMENT Nlateria[C cY± c No: Compartments ---- Capacity a "`� TYPe Distance to nearest: Well ------- -------�`-------- -Foundation - j a------------ Prop. Line ---------- ----------- LEACHING LINE [ ] No. of Lines ----- ------- ---- Length of each line--------------------- ------ Total Length _------�--- ---- 'D' Box 1__.__ Type Filter Material SPS le /G---�'-` _0epth Filter Material --___l_- ____-_."a_ h Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ________________________ SEEPAGE PlT [ j Depth --- Diameter ---------------- Number -----------------T---------- Rock Filled Yes ❑ No'(-]Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance ----------- - --- - -Distance to nearest: Well ----------------- - ----Foundation -------------- - --- Prop. Line REPAIR/ADDITION(Prev, Sanitation Permit# _.------------------------------------------ Date -------------------•--------------) Septic Tank (Specify Requirements) -------------------- --------------- Disposal Field (Specify Requirements) -----------_ ----------------- ----------------- ----------------------------------------------------------- ------------------------------------------------ --------- (Draw existing and required addition on reverse side) 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. 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 become subject to Workman's Compensation laws of California." f- Signed - ----- -------1'------- -------------- ------------------------------ Owner --- Title BY _ � ----- -- ---------------------------- (If other than owner) ' FOR DEPA ENT USE ONLY k APPLICATION ACCEPTED BY _._____ ---------------------------------------- DATE ---- - -"'_� -----�- - - - - - - -------------------------------- DATE ------------------------------------------- BUILDING PERMIT ISSUED ----------------------------------------------------------- ADDITION L OMMENTS "--------------- ------------ ""ar , MJF r t,:_ - R --------------------------------------- -- tLtti x f - . J_ _ :--:. Final Inspection by: _- --------------- ------ -- __Date ` N JOAQUIN LOCAL HEALTH DISTRICT F H 9 1-'68 Rev. 5M.