74-409 - Laserfiche WebLink

Home Browse Search

0 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ...7�- ��•9 = (Complete in Triplicate) .............. Date issued This Permit Expires 1 Year From Date Issued it Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein l described. This application is'made in compliance with C unty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ... ..��1��.�J�..-.. ..................... . ....... .-.. CENSUS TRACT .........:......_..-._.... �.e. 1 .p w.. ... ... _ Owner's Name :.. .., . . :. ... .................. Phone .................................... Address .. -..-••••-•-- i ...... ................... �1 ty Contractor's Name,_-.-..-. .�.... ( ""`{....License # Phone .............................. Installation will serve: it Residence Apartment House Commercial ❑Traller Court 0 u Motel ❑Other ----• ........................... Number of living units......... Number of bedrooms _..�f......Garbage Grinder ............ Lot Size ..__ --------- Water Supply: Public System and name .......•........-------------------------------------- ........................................................Private [� Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat E] Sandy Loam C1 Cloy Loam ❑ Hardpan ;I" 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 availaa within 240 feet,) ry y � PACKAGE TREATMENT [ ] ;', SEPTIC TANK fe Size.�_.�.L.P..--r+_---�--•--•-•�---.:.-..Liquid Depth .._y-_.....__._•-•-•--•- Materiai___L°r�!- -�•• No. Compartments Capacity J .._r`Z-.....•••-•• 1 &P-0....-- Type - d �i r ... Distance to nearest: Well ..........5.Q....................Foundation .........�.C�.�._. Prop. Line :. ............... -...�� LEACHING LINE [ No.illof Lines -------_ ---------._. length of each line-•----' p `-....... Length ._/ �'_._.:. 'D' Box ... .... Type Filter Material 4 .....Depth Filter Material •..............•-•---:: i ` PropertyLine 5::................... Distance to nearest: Well ...... -----•-•-••- Foundation /l7..--- •••-••---- SEEPAGE PIT [ Depth ..._ i_-•- Diameter _ ".x-=- Number .............3......... Rock Filled Yes yNo t❑ /J Water Table Depthf1.�..-----_'.--•--•:..._._.:.-;Rock Size - .'1 .. �.3__.__.---• V) a� Foundation ....1.O_......... Prop. Line --- Distancel to nearest: Well ..------..,1__....•.----•-•- -...._... REPAIR/ADDITION{Prev. Sanitation Permit+# --.-----•--------•--------- ................ Date ................................... Septic Tank (Specify Re uii arements) ------ ............................... ..................... _ (� Disposal Field (Specify Requirements) -.-_-------- ---------------------------••-----"•-------------- � .............................. •-• .---•-----•-••---.....----•-••--------•---------------•------ ••---•••-•---......••••--....---••-••.......--••---•--•- (Draw existing and required addition on reverse side 1 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- std agents signature certifies the following: "I 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 Workman's Compensation laws of California." Sig ned ------------------ Owner i By ..- ----------------- ----••--••---- (If other than owner) -FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B _ !� Y rte.. -. DATE ....... ..................... ............................................................. BUILDING PERMIT ISSUED 2 ..-....................................DATE ........................................ ADDITIONAL COMMENTS s -----••----•.. ---- --------------- -•••-...............---•••-•:............I................... ........... ........ --•- i " ----------------• -----•---....-•-------.....---•-----••-....----- ..•--.-................ :........................•----- .......... ........�- --:....---- :. Zr .......... ..............I..................... n... a -.._:_............_._� at8 f Final Inspection by: •.................. ............. . D SAN JOAQUIN LOCAL HEALTH DISTRICT 7/72 3 ,K c u 13 24 1_•AVt 9.v RAA _