70-770 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----- --------------=-- -------------- -- (Complete in Triplicate) Permit No:7D_--2. 0, ------ This Permit Expires 1 Year From Date Issued Date Issued A 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 ...�_ 71 -------- 4-- -- L?.6kQ-- -------------CENSUS TRACT ------------------------- Owner's Name --t-.11,? 2 - -C'�� e�' r1 L?i 1 Phone _g--.------ e--9/-------- Address ------------------------------------------------ . Cit P-49-t2 Contractor.'s Name .._� .......1 .f2f-_--____ -----------License #Q_fl�- / -- phonemic �+(i Installation will serve: Residence [14Wo-rtment-House❑'-Comrriercial ❑Trailer Court ;0 Motel ❑ Other ' Number of living units --- Number of bedrooms .-------Garbage Grinder -------- Lot Size ___l�`r�--------------- Water Supply: Public System_and.name -----/ /�fl!_ - ------(�PfC-A---------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand-'5?' "Silt❑ Gay ❑ Peat ❑ Sandy Loam ❑ Clay Loam .0 ` Hardpan ❑ Adobe '❑ Fill Material ------------ If yes,type ---------------------------- (Plot ---.- .._.__...-. (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 pubic sewer is available within 200 feet,) 1 PACKAGE TREATMENT [ I SEPTIC TANK [ ] Size....__ - '`_ --/d (� Liquid Depth Ca acit . Typeateria ._.d-VI--Q2,e-4o. Compartments 2-' -------- ------------- Distance to nearest: Well Sid-- Foundation -a----------- Prop. Line --- LEACHING -LEACHING LINE [ ] No. of Lines :___ Length of each fine.-._ - ...._ Total Length --------- 'D' Box ------------ e Filter Material -i2dc -11 YP -- --------Depth Filter Material ..-�i.�a----------- ------------------ Distance to nearest: Well __'__67P------------ Foundation ...!__0............... Property Line ..-s��.....-._..- SEEPAGE PIT ) [ ) Depth -------------------- Diameter ---------------- Number ------------------------ --- Rock Filled Yes ❑ No C Water Table Depth ------------------------------------------------Rock.Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------- ----------- f REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------------ Septic Tank (Specify Requirements) --------------------------------------_.._.-t - Disposal Field (Specify Requirements) __-_----__--- F ------------------ ------------------ ----------------------------------------------------- -------------------- (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 i 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: "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Wor an's Compensation laws of California." Signed ..._V ;9111 �_4- ---- --------------------- Owner BY - -- - -- -- ---- ---------- (I ---- -- Title ----------- - ---------------- ot er#han owner) FOR DEPA'1tTMENT USE ONLY APPLICATION ACCEAED BY ...-._ �` a---------------- i ----------------- - ----------------------- DATE -------------- BUILDING PERMIT ISSUED ------------------------------------------------------------------ -------------DATE ----------------------------- -- ADDITIONAL COMMENTS --------------- [ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ---------------------------------------------- ----------------------------------------------------- -------------------------------------------------- ------------------------- ------------------ --------------------------------------------- r ----------------------------------------------------------- ----- --------------------- - --- - ----- - ------ ----- ------- - -------- Final Inspection by: . ---- ----------------- ----------------- ------- -- 1� ----------------,Date ---=- --- --7 ��----- --- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev, 5M