72-94 - Laserfiche WebLink

Home Browse Search

Fc�i2 OFFICE USE: APPLICATION FOR SANITATION PERMIT ---- (Complete in Triplicate) Permit No. ---- 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 m de iin// compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..___ �7__ __,_7__.______ ------__Lf-�H�1L______. .___..CENSUS TRACT =5 --__--.---- Owner's Namef �_r _ }�-i = G Phone �- �y Addr1.ess ----------- -------/�--- -- ------S---=--------�i---- -L--J---------AJ-- 1--.'city --- A ---------------------------------------- Cont�actor's Name ----- .Qct----- -E ------------------� _.;:�. _=---�Licen e# -- -----. Phone ----------- t I i Installotion will serve: - Residence partment House©-Commercial-E]Trailer Court._,E] 4 i i to e! F-1 Other _,.____ I� � . Number of living ur�its:__X,_____ Number of bedrooms ______.Garbage Grinder i Lot Size _fTC_ &�.-----.------ ! ___-_Private Wat it Supply: Publit''s�+sf�m and na�e ---------------------------------•--I - - � --- -�-----•_---•----•-•---• ❑ Character of soil to a,de th of 3 feet:Ha�ad SAdobe CI Fill Material _____�Sandy' l d esot me ClayLoam P ❑ Y ❑ C� P a ❑ 1 Y� YP -------- ------------------- (Plot 'Ian, showing•#size of lot, location of system in relation to wells, buildiings, etc must-be placed on reverse side.) NEW'INSTALLATION- (No septic tank r seepage pit permitted public sew'-Fer av ilable within1200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK f ] Size__________ _______ _________ Liquid Depth ________._______.__.,..-_. f Jf Capacity ----------- -------- Type -.1----------------- Material------1-_} --- No. Compartments Distance to nea est: W+C Ii jf------------------------- Founda-fion r -------------------- Line ----•-- -------------- ------ LEACHING LINE { ] Na..of_Lines_ i___.._____l _ jLength of eachline------ ----------i Tota! .L"ength '+Di,�Box�___,lype,Filte� Material ____________________Depth Filter Material IG ~� Distance to near st: Wellc)__i__________________ Fou _____.______ __-_______ Foundation _ Property Line ------------------ t SEEPAGE PIT [ I Depth ------- - Diameter)-j�-------------- Number .---------------- _________ Rock Filled Yes ❑ No 5j Water Table De th ---------- [C` --------------- -------Rock Size - ------ ! Distance to nea st. Well -- --_-l�- ---------------•_-•_--.....Foundation -------------- Prop. Line -----------.--•-.•_-. REPAIR/ADDITION{Prev. Sanitation Per _ +----- -----------,-Date _ ] ---------- -------------------------- - -------------------- Sep tic Tank (Specify Requirements) ---- ----- -------------------------------------•------• 1 Disposal Field (Specify Requirements) X___77 X---"------ --------'- �i- r--- �- ifs ` O I— �` LE�4f-N [-! — f) - 'ti- - - - - 1� r X ------------ ---------- ------ --� -- . ` e _ P� ----------------------------------------------- ----------------n --------------------------- - _ . _ i (Draw existing and required addition on reverse side) I her by certify that I have prepared)'this application and that the work will be done in accordance with San Joaquin a County i0rdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents si ture certifies the folo ing: "I ce ify the pert I nee c a work for which this permit is issued, I shall not employ any peon in such manner as to bec a sub)ect to man's ompensat ion laws of California." ----- ----------------------------------------- Owner BY ...E -;..- --------------------------------------------------174-R•-4P----- Title j (If other than owner) FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY C --------------------------------- DATES ; `. Z- P BUILDI-NG�-PERMIT-•ISSUED- ---- ----- - ----------__--- —DATE ADDITIONAL COMMENTS --- -------------------- --------------w--------------------- - ------------- 11s t � \' � -----------------k--------------------- ------- ---------------------- -- ------- ------ - --------- ---- --- ----------------------------------- ------------------------------------ ------------ ------ --------- ------ -- ------- ---�--�--�'---- -- -- ---- -- - - - - - ./ Final Ins ection ------------------------------------Do -� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M