72-1091 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT {Complete in Triplicate} Permit No. -----_-__________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 with County Ordinance No. 549 and existing Rules and Regulatlons: JOB ADDRESS/LOCATION -1--- - -� ---�' L - -----------------------------CENSUS TRACT --- '- --�.---- Owner's Name --/t - '_s ------------------------- -------------------------------------------------Phone `�= /-�-_C 1 , Address -- �--- �------ -=� ,, � Y -��-- ---�- - - ---- --------------- ---------------•-•--- y- ----- -- - - �---1��--Q--------------- ---- -------. cit Contractor's Name _. I._441 ` C, [ 2 ~. -� -------------------- License # _ `� � - Phone - _ Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court Motel [❑ Other -------------------------------------------- Number of living units:---- ------ Number of bedrooms _3------Garbage Grinder _L�,t1Lot.Size -;________ Water Supply: Public System and name ----------------------------- ---------------------------------- .............---------------------------- 'Private.. �i } Character of soil to a depth of 3 feet: Sand' R Silt❑ ? 'Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ----------._______________ (Plot plan, showing size of lot, location of system relation to wells, buildings, etc. n3ust''be placed on reverse side.] NEW INSTALLATION: (No septic tank or seep a pit permitted if public sewer is available within 200 feet,) 1 PACKAGE TREATMENT { ] SEPTIC TANK' Size- _.-4'f G_-1y�_.-I _____.___ Liquid Depth city _/�,_a__`______ Type Material_ .t No. Compartments ____� ......__ istance to nearest: Well ______:-�!�-_�_.__-___-._ Foundation -----.�_-O----------- Prop. Line _____.��___________ LEACHING LINE No. of Lines ----�-------------- Length of each ,line___3Fd---------------- Total Length ____1 �77�_________..._. `D' Box _9 ,_#_�,Type Filter Material _1Y ________Depth Filter Material ------ -_______________________________ - �-�- Distance to nearest: Well -----,5'- ------------ Foundation _1_4?--------------- Property Line ______-__--_ SEEPAGE PIT [ ] Depth _._ Diamete --- Number ____.__.-2—------------ Rock Filled Yeses]' No i❑ Water Table Depth --------------------=---------------------------Rock Size -------------------------------- Distance to nearest: Well ------------=---------------------------Foundation -------------------- Prop. Line ---------_----__---..- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------- Date ---------------------------------- Septic ---------------------------------Se tic Tank (Specify Requirements) -------- ;: " ' = A--------- `=..- ----------------- Disposal Field (Specify Requirements) ;'-------------------------------- -------------------=------------------------------------------------------------------------------- ---------------------------------------------- Y , -------------------------------- - (Drdw 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 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 ByC- Z !a'/ -------------------------------------------------------------- Title ------------------------ (If other tha ner) FOR DEPARTMENT USE ONLY- -7 NLY T 'L-_ APPLICATION ACCEPTED BY ---� �,---- -------- ------�----- --"-----�;--- ------ DATE -----A---- 31 BUILDING PERMIT ISSUED .. _.__-._.:. -------__. :.- ------------------------------_---_T_: --•- ----DATE ADDITIONAL COMMENTS ------- -r4l- - ------------ ---------------------- - - --------- ---- -- ----------------------------------------------------------------------------------------- -------- -------- ---------------- --------------------------------------- Final Inspectio - Date______ -- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M