73-345 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: "-_ AAPPLICATIONFOR SANITATION PERM 3-3fl� 11 L Permit No. . ................ - (Complete in Triplicate) .... i 'i Date Issued This Permit Expires 1 Year From Date issued Joaquin Local health District for a permit to construct and install the work herein Application is hereby made to the San described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ,. .. S. �TA./II,ICG— CENSUS TRACT ...... _.... ... - t Owner's Name .._. •....IC'x'5,6_----•---•----..... ••••--------------- ----- Phone .-5. -.. =... Address �, -.t�._�-..._-.��----��.rr4. f_� City �J .._..License # Phone ��_ . .._. Contractor's Name . Installation will serve: Residence jK Apartment Housef❑ Commercial ❑Trailer Court ❑ Motel ❑Qther.._...._...._....-----_---_ .-.----- Number of living units:.._-j_..... Number of bedrooms ._....Garbage Grinder _ ------- Lot Size Private Water Supply: Public System and name _--_-_---------- ----------------------------------------------- = f� Character of soil to a depth of 3 feet:l Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay Loam [I r Hardpan ❑ Adobe N Fill Material ------------ If yes,type I (Piot plan, snowing 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,] p t D� r _ a- ................... Liquid Depth ...._.._. ............ d PACKAGE TREATMENT [ ] SEPTIC TANK T ] Sizei...� Capacity _ Type ..._:. "_a Material.-G_. L-r��C- No. Compartments .. ................... ___.Foundation .. _D� Pro Line __-. ..----- Distance toy nearest: Well 11 S'Y ._. ?_.{� ••_- p' LEACHING LINE [ ] .._... Length of each line._7�................. Total Length ..ham-,----•--•-•--••-. s ... �------- � vz.c Lam. D' Box .. . Type Filter Material .----Depth Filter Matenaf .----. ---...---- -• _..--_....- Distance to�nearest: Well Q��'`.. ..�f_ Foundation ��.... .............:.. Property Line ........ ..................... 5�-►-q [ ] Depth . ........ Diameter�_�.g._--. Number ----------1-1 ...... Rock Filled Yes No C �r Water lab a Depth -- ---- 7 _- .............Rock Size -------Z ��------.._ .:_-------•--•-- V. - Prop. .S_. ._----• -•- �—Distance to nearest: Well __DUPr-_- - ..........Foundation ----1f -.•- line REPAIR/ADDITION(Prev. Sanitation ;Permit# .................................•---------- Date .............•------------ ------- Septic Tank (Speci Requirements) l t I i ......................--------------•- Disposal Field (Specify Requireriientsl ------- ------ - ...................... �..- - ----- ------------• ---- •----- -------- ---------- .__-------------------.---..-_....__...- . . ..._.-. v - ----------------------------------------------- j ! . . (Draw existing and required addition on reverse sidel •- 1 hereby certify that I have prepared this application and that the work willbe done in accordance with San Joaquin County Ordinances, State. Laws, and Rules and Regulations of the San Joaquin Loc 1 Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work far which this permit is slued,l shall n employ any person in such tnannw as-to become sub[ect o Workman's Compensation laws of Coliforhia.r' --- / ___-----•-------- --•-•---- Owner Signed ._ . o ��`��" -----------•-- By -•---•• Title ..-.-. ............... ....:........... ... i . .;��lf other than owned-�-•----- -------------------------•-•------ ,. NLY ". = DATE FOR DEPARTMENTt USE O APPLICATION ACCEPTED B I... v�r--._..:..............:..................... ADDITIONAL: OMM NTS -------_---• i_------•-----------• - •--------_---------• ------------- - ------_._... . =. .1 .... �... . _ ---.... ..... _.. ---•................... ........ ----- . . ......... ........:......... i] ....... Final Inspection b . ate SAN JOAQUIN LOCAL HEALTH DISTRICT I - 717232%1