72-141 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE. `- APPLICATION FOR SANITATION PERMIT f r k (ComplePa in Triplicate) Permit No.. �- /- •�_. - ------------------ -------------- _. ---------------------------- "---`---- ------ This Permit Expires 1 Year From Date Issued Date Is I ed _Z:_- I 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 complia ce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC ON ------- ------- #CENSUS TRACT 1 Owner's Name --- e . 1. Addres -----, -, - --- _- _ _ city -- - 5r P-,o ne ---� City---------- .. �-- , ------ -•-------- ••--- - Contractor's Name ---- A � � --.License #-�S�f� j__ Phone --- ----- Installation will serve: Residence [9'Apartment House❑ Commercial ❑Trailer•Court ;❑ Motel ❑ Other f i Number of living units:.__. Number of bedro s _______Garb - .- ,5 ge Grinder Lot Size Water Supply: Public System and name __. .------ -------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam .0 Clay Loam ❑ Hardpan ❑ Adobe ill Material ------------ If yes, t t I (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 feefi,) 1 PACKAGE TREATMENT f ] SEPTIC TANK LCY Size la - � Liquid Depth _ - ------------.----- Capacity 1-2OV------ Type p4e_ _ Material ---- No. Compartments ------y Distance to nearest: Well _- Foundation*`_ --- 4 - ------ Prop. Line -------1.-...... LEACHING LINE k��No. of Lines -----__ ______- Length of each line------------------------I ' _,,, Total;Length_ ----------�-L---_ 'D' Box ------ Type Filter Materia! - ___-____________Depth Filter Material _` Distance to nearest: Well Foundation ------------------------ Property Line _SEEPAGE PIT [ Depth ___ ____-- Diameter ►j�` „ ,----fr---_ Rock Filled Yes'®� Na4. ❑ ��- ,Number _._ Or Water Table Depth -------- � Vg -__ -______ ___ _---__Rock Size _ - -- ------- ----- - Distance to nearest: Well ------ i_•_----_ -__Foundation 41 - - - ��------._ Prop. Line __.�----•---------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------•_--_-- ) Septic Tank (Specify Requirements) _____________________ --------------------------------------------------------------- -------------------------------- --------- -------------------- - ----- Disposal Field (Specify Requirements) ________________ ---------------------------------------- ------------------------------ -- --------------------------------------- ------------------------------------ _ a - ---------------------------------- (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. Horne owner or licen- f sed agents signature certifies the following: 4 "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner asto bec7lre sub' ctl to Wo an' ompensati.on 1 of Cplifornia." Signed _ Owner----- ------ --------- BY ----------- ---------- -- ---- ------ Title ---- --- ------ --------- - � ------ (If of-- --t now er) --------- ---------- --------- R D PARTMENT USE ONLY t APPLICATION ACCEPTED BY -------- _____-- DATE - BUILDING PERMIT ISSUED -__-- ------------------ - A TONAL COMMENTS ---- 11 • r-� ------------ -DATE ------------- --- _- :a t s yl .- '----------au -� -1--/f--- -- ----------�'` �y ' —--------- 4•r `��-'� ��--Fid'- - --� �3 - � - D!+ - --- Y -- ----------------- ----------------- Final Inspection b ---- - -- - - ---- - ---------------------------/P---�i P Y Date ., --------------- AN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev, 5M