73-813 - Laserfiche WebLink

Home Browse Search

f FOR OFFICE USE: F APPLICATION FOR SANITATION PERMIT 73—��3 ..............•----- Permit No. .......... (Complete in Triplicate) ......................:............................... This Permit Expires f Year From bate Issued Date Issued :i . 3.... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described.11 l is application is made in compliance County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO ...1��I ...` ..-.�- -) �-c�vw... :, ......................:....CENSUS TRACT .......__............ :.... Owner's Name ..... . . o`". r,. .................................... Address � h ��.:_ _ ...................... City ....---._..... ..j 7. f Contractor's Name .. ..._.... .................•---.... .......................License # ................. Phone .......:. ' :: .._..-:-._... Installation will serve: Residence>(Apartment House❑ Commercial ❑Trailer Court; 0 Motel ❑Other 0 1 - Number of living units:....-1____-- Number of bedrooms �.......Garbage Orinde"ryA Lot 51z _Q S?�RA-__.......--•....---: Water'Supply: Public System and name ...•--•._..._.....•-...--•--.-......, ..-.--•- '�'._---.... 4..�`:_.- --r .__-...Private `� � r.._ Character of soli to a depth 3 feet: Sand❑ Silt❑ Clay ❑ Peat`❑ Sandy Loam Clay Loam ❑ '� Hardpan [3dobe ❑ Fill Material ......._. If yes, pel f....... ....... {Plot plan, showing size of lot, location of. sys em in relation tow�, 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,) i PACKAGE TREATMENT [ ] SEPTIC TANK j � Size................••-----...--•--:.... ----------- Liquid depth .......................... tt ��11 Capacity .�a .. Type•' ._ Material.C ,.. No. Compartments ...:QS............:� ' Distance to nearest. Weil _ 4 _ . ............Foundatio- n ...k.-di-............. Prop. Line LEACHING LINE, No. of Lines . _� .......... Length of' each line.... - ------------- Total Length . ............gyp ...._�$L?..............1` 'D' Box ... ---- Type Filter Material _��. Depth Filter Material .....�_.1......•.....� ..........:...� Distance to nearest: Well AW-'..._-.--.:._ Foundation _... ............... Property Line SEEPAGE PIT [ ) Depth 1-0.1 ........... Diameter g. Number .. ..4 Rock Filled Yes No ............ 14 Water Table Depth ...........................•-...'•• Roc Size .........._.......... .......... Distance to nearest: Well .........Foundation .... Prop. Line ...:........... �,✓ ........................I ._ M REPAIR/ADDITION(Prev. Sanitation Permit# .................................�-......... Date ............................... SepticTank (Specify Requirements) ........................--------------------------�'y`-�-- ----------- .........,............................................................ : Disposal Field (Specify Requirements) -----------•--••----••------•--• ....................... .........................•--...-•-----•...... ---------------------------------- ------------------� ------------------•----------------------- ) .-- - --- --........_..........._._....---•-•---._...._............•--•-••---•- 14� -------------------------------------------- .......I......... .... .-• --••----•----•••--....._.....---•-••......------••....•---- (Draw exi`ng and required addition on reverse side) , -.. I hereby certify that I have prepared this application and that the wark,Will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regi lations of the"San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: i "I certify that in the performance of the work for which th r it is issued, I sh6ll not employ any person in such manner as to becam ubject to War n`s Compensation laws of California." Signed ......__- - -......................................... Owner By ................. ........................................ ............ Title :....... ...... _.._...-----------------•--..................._.......: ...................I... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y .... .... . . . . . .... ............................................................... ........ DATE DATE ..... '.�� .._............. BUILDING PERMIT ISSUED --- --- .... ...... ........••..... . DATE . ' ADDITIONAL COMMENTS _.....--- `' ------------------- �_.__.......-- rt}... f ..� ...... _ ................. ...............................................---•-••--•---•----•---•--••--••.....----------•-------•-----•---•-._........_•-•---•...........---••-•--•----...................... ,. ............................... .......................................................................................-------.....................-------............................. Final Inspection by ................Date ....................................... SAN JOAQUIN LOCAL HEALTH DISTRICT c i. 71 Ila ,