74-754 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATI61440'R`fSANITATION PERMIT ------- ------------------ Permit No, . _ (Complete in Triplicate) --------------------------- � �u 7 This Permit Expires 1 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 made in compliance w' h County Or inance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _____-- -�9�� CENSUS TRACT ----------------------- Ip -------- --- i Owner's Name 6W. _ ----------------------------------------y-------- ----------- ---Phone Address -_.fit-a ��jIl --------------------------- City -C_1_j- - �} C / License .cf�d' -- Phone 3� _ Contractor's Name ------ ..--------- rZ FZ1-`�------------------ -- . Installation will serve: Residence�a Apartment House,❑ Commercial :❑Trailer Court ;❑ Motel ❑ Other ------------------`,----------------------- Number of living units------=------ Number of bedrooms ------------Garbage Grinder ------------ Lot Size -- _ �--.------------ Water Supply: Public System and name -_----_-----_--------------------_---------------------- --------------•-------------- ---------------------Private Character of soil to a depth of 3 feet: Sand 1 Silt❑ Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ 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.) seepage pit permitted if public sewer is available within 200 feet,) I NEW INSTALLATION: (No !septic] tank or �.l PACKAGE TREATMENT [ ] SEPTIC TANK'[ ------- Liquid Depth y ------------ 9 i Capacity ab------ Type2f Material- �/+- lo. Compartments ---•.•-------- / d Distance ,to nearest: Well _--_--�_©-__________________Foundation ---/_____.___ . -__ Prop. Line _--_ --_.-._.- a 1 LEACHING LINE [ j No. of Lines -- __.____--_----- Length of each 1• e-- - --------- ---- Total Length - _-_--__-_._.-_ m D' Box --_ --__-- Type Filter Material 1------------------Depth Filter Material __ ------.-_-------__-.._-_-___--..- Distance to nearest: Well --------- ------------- Foundation -------------------- -- Property Line -----_--__--_--....-. SEEPAGE PIT [ ] Depth ---1---------------- Diameter --------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ � WaterTaI ble Depth ------------------------------------------------Rock Size -------------------------------- i Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line ------------------_- - REPAIR/ADDITION(Prey. Sanitation 6 Permit# _-._-_- ------------------------------------ Date --_-_--_----_--_-_--__--_-_-_-_-_} i Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------------------:----------------- -._.-. S— DisposalField (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- r ------------------------------------------------------------- -------------------------------------------------------- --------- --------------- ----------------------- -- -- ------------------ -----------------------=-------------------------------------------------------------------------------------------------- k (Draw existing and required addition on reverse side) I hereby certify that I have prepred 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." Signed --- -- - ---- --- -------- -- -- --------------------------- -- -- --------------------------- Owner By ------- --- ------------------------------------ Title ----- -- - ---------------------- -------------------------------------- (If of er than owner) FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ----- --------------------------------------------------------------------------------------------- DATE -------- ---------------------------------- # BUILDING PERMIT ISSUED ----#-- --------- -- DATE ------------------------ ADDITIONAL COMMENTS - -------- - � -- = _ -_ - --------------------------- - -. --------------- - ---- - , --X - 2, -- ----- iq - Final Inspection by: - o ._- -- - --- - ---------------------------------------- Date _ SAN JOAQUIN. LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M _