72-1103 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............ ,/ 3 Per No: _711-=-163 +t, . (Complete in Tnohcatel Date Issued -------- -- --------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in .compliance with County Ordinance No. 549 and existing Rules and Regulations: ? CENSUS TRACT -------------- ----------- JOB ADDRESS/LOCATION ----� f`'-- � /� -------------- Owner's Name --- --------------------------------------------- -----' --------Phone --------------------••-------------- Address `' � «� P* -�- -��--"--'------------------- Citya - ', Contractor's Name . �`� �j -- ---------------------------------------License # 1 , ---- Phone'je�_� Installation will serve: Residence,KApartment House F1 Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- .� s Number of living units:-./----- Number of bedrooms ------Garbage Grinder -- Lot Size /gyp ----------•- { Water Supply: Public System and name -L� �"� Private F] Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Jam'' 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 available within 200 feet,) s PACKAGE TREATMENT [ ] SEPTIC TANK Q ize- - -- ------------------ Liquid Depth ------------- w ____ Type /` -- Material_&P/7 -___ No. Compartments ----------------- capacity/41K le Distance to nearest: Well ....-�------------_-------Foundation _tea------------ Prop. Line LEACHING LINE No. of Lines —-------------- Length of each line-_41162-uP----------------- Total Length 4.7--.---------------- �`' 'D' Box - Type Filter Material zJ�9Depth Filter Material`e�11--_______._______________________ E dr Distance to.,near Distance Well ..--_-`—___- __. Foundation ,V-_____________, Property Line _�--------•__._.. SEEPAGE PIT Depth -��------- Diameter _--___ Number ----------------- !Rock Filled Yes ' No Water Table Depth - --------------------------- --------Rock Size/-_- -- ------- - ------------- - Distance to nearest: Well ------�-rr^ '----------------Foundation -0914-1 Prop. Line .._..__.______....... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) r Septic Tank (Specify Requirements) -------- ---------------------------------------------------------------------------------- ---------------`,----- ----------•---------- Disposal Field (Specify Requirements) __________________ ---------------- `---------------- F _ _ _______________________________----------------------------------- _ i (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'L6ws,`and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certilfies the folI*wMng: "I certify that in the performance of the work for which this permit is issued, )'•shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." y Signed --'----- --- Owner--------------- -------------- By _ -____--- ^-- �d ------------------- Jit1e - of er than owner) ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ DATE ---1/.---1 d--r---7Zi BUILDING PERMIT 155UED .__._______ --------DATE ------------------------------------=------ ADDITIONAL COMMENTS ------'--------- ------------ ---------------------------------------- e = e...., - '- ----------- --------------------- -- -------------------------------------- ---------------- -------------------------------------------- -- - -- -- 4� , : ---------- ------------------------------------------------------------- ------ ----------------------- --- i ---- 017 Final Inspection b ----------------------- ------------------------------ Date P y: ' -- -� a SAN JOAQUIN LOCAL HEALTH DISTRICT