73-673 - Laserfiche WebLink

Home Browse Search

r - FOR OFFICE USE: APPLICATION TOR SANITATION PERMIT ' - ---- - --------------- ---- Permit No: (Complete in Triplicate) --- --------------------------------- --------------- a,73 -------- 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 Regulations: JOB ADDRESS/LOCATION 1.975Y------6------....S"UT--_I_FF----------------------------------CENSUS TRACT __ }__< ------ Owner's Name .---- G,�..oF�--------- ------�f L� ET` -------Phone :__--------` Address ------- City ff w�?� 1 Q --- y --------------------------------- ------- --- ------------------ Contractor's Name ....0 l//V-f-R--------------------------------------------------------------License # ---------:-------------- Phone .----------------------------- Installation will serve: Residence ❑ Apartment House-E] Commercial ❑Trailer Court Motel ❑Other ------------------------------_-------------- �/' Number of living units:.__------ Number of bedrooms _2----Garbage Grinder --IVB Lot Size R. / ------- Water Supply: Public System and name ________________________ `- _--------_-Private r Character of soil to a depth of 3 feet. Sand'❑ Silt El Clay E] Peat E] Sandy Loam -E] �' Clay Loam 2 Hardpan Adobe ❑ Fill Material If yes,type :_______'__________________ (Plot plan, showing size of lot, location of system in relation to wells, buildirigs-etc., mu'st be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avaiiable'within-200 feet,) PACKAGE TREATMENT { ] SEPT IC—TANK`[ ]' --------..Size_ `------------------ ------------ --------{ Liquid Depth ----------------:--.-----• - y ------ Material-----.` '--------- No. Compartments ------ --------------- Capacity -E------------- TJ!pe------- Distance to nearest:, ell -- ---------------------------------Foundation -- ----------------;-- Prop. Line ---------•.--_-------- OQ LEACHING LINE [ ] No. af'Lines ___________ _.------ ELength of each line----- ___-___ —___ Total Length :___________________________ E its �—,� Ul 'D' Box ------------ Typ kilter Material --------------------Depth'-,Filter-Material ' f_--------------------------•--------•---• 1� Distance to nearest: el!_�_______________________ Foundation -________-- .____-____ Property Line -------------- -_--_-___ . i r F SEEPAGE PIT Depth __---__ Diameter ________________ Number -___;_.__________- -- ------ Rock Filled Yes ❑ No [ ] P % < Water Table Depth =--------------------------------- -------Rock Size ----- -------------------------- V) _.ell •------ ----------------------=---------Foundation -•---- Prop. Line --------------... Distance to nearest: ell Date - ) 4 REPAIR/ADDITION(Prev. Sanitation Permit Septic Tank (Specify Requirements) --- ----- --------- -' r .h Disposal Field (Specify Requirements) ---- --------- ~--------- "h t - --- 1 ------- _r_--------�'1-T"-------------- ----------- --------- ________.___________.__-______________-_____ - E F ______________________________________ _ _____________ -__..__-_--------._-__ _ -----------------------------------------,----------- (Draw existing and required addition on reverse side) I hereby certify that I.have prepared this application and thay.the work will be done in accordance with San Joaquin- County Ordinances, State Laws, and Rules and Regulations'af the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify ttA in the p rformance of the work for which this permit is issued, I shall not er'ir ploy any person in such manner ----------------------- By w as be me subj t rkm s m tion laws of California." , _i Owner Signed __. BY ----------------------- ---------------------------------------------------- P► = --- Title --------- ---------------------------------- -------------------------- (If other than owner) FOR DEPARTMENT- USE ONLY k APPLICATION ACCEPTED BY ---------- - f ---------------------=------------'---------- -------------I----•-----. DATE --- -- -7-� BUILDING..PERMI7._1SSQED_ --------------•: __, - `---------------:----- _ ----------:_---.- _: ----- DATE ---------------..----- -------- ADDITIONAL COMMENTS ---------- ------------------------k--- --- ---------=------- - ----------------- --------------- �. ---------- ' -h --------- -------------------------- -- - - -- - -- --- ---------- � ,yam - --------------- Final Inspu---Rj _ -- - - �------------------------------------.Date -------- ------------- SAN --- --- --- ---- SAN JOAQUIN LOCAL HEALTF DISTRICT E. H. 9 1-'b8 Rev. 5M