72-1158 - Laserfiche WebLink

Home Browse Search

a Ks. � FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.72_— /t�91 ------------------------------ -------------------------- ------------------- (Complete in Triplicate) f Date Issued i2_ -----------------------------------------"-" -------_ " f 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: JOB ADDRESS/LOCAT ON---�_/ [7 5 ?__ � '`- -- F�------- ------------ --CENSUS TRACT ---- l f Owner's Name - L- L- _ -----------:----------------- -----.-Phone - - �J �_J�-�------ . Address - - ll�-y OT4/ i °----- City -- C�} LO - - -- --------- �LSQni` ,C1�-4!'� 101< - �_�CLicense # Phone ------------ -------------•--.. Contractor's Name _..___.-- - Installation will serve: Residence p+ikpartment House❑ Commercial :❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living uriits: ---.- Number of bedrooms _ ---__Garbage Grinde Lot Size Ci�_,e7-4&Z------------- Water Supply: Public System and name ___-_------- - Private ❑ Character of soil to a dept] of 3 feet: Sand❑ Silt❑ Clay ❑ PeatSandy Loam ❑ Clay.Loam ---- I Hardpan�jin ❑ Fill Material 56--- If Yes,type ------------------------ (Plot plan, showing sizea'of lot, location of systlation to wells, buildings, etc. m st be placed on reverse side.) NEW INSTALLATION: (No septic tank or seeparmitted if public sewer is availabl within 200 feet,) Vh PACKAGE TREATMENT ] SEPTIC TANK I ] Size----------------------------- ----------------- Liquid Depth ------_--------------.----- V} Capacity ---------- --------- Type ---- --------------- Material------------- -------- No Compartments --------- ------ Foundation ' P,1op. Line -------------- ---•--- Distance to nearest: Well ----- -------------------- --------- LEACHING LINE [ ] ------ nth of each line ---------------------------- otal Length ------------ -------------- LEACHING --- k No. of Lines 9 \D' Box .----------- Type Filter M tenial --------------------Depth Filter Mat ial1.--------------------------•----- •• I t Dis#ante to nearest: Well ______ ----------------- Foundation ___ ------------------- _ Property-Line ._______----------•----- SEEPAGE PIT [ ] Depth ---------- ------ Diamet ---- -------.-Number;--------f--------------- Rock Filled Yes ❑ No G t �. - __ P_ - `Rock Size .: ---------------- Water 071 -�Disfiance to nearest: Well ____-- I .-Ta e Depth ' Foundation ---------------- -_. Prop. LIR@ ______________________ REPAIR/ADDITION Prev:5anitation.Permit# _ l.'T1 CIS-- � i�-� '� { . i I----- "-. . O L: -1'1'1- -Nr' �------------ Septic Tank (Specify Requirements) .�----------- '� �� _ R --`--------------------- - ------• _ -------- Disposal Field (Specify Requirements) �--""""�""""" •• -- --- (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 Laws, and.Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- r sed."agents si _ature certifies the:following: k ertify th in the p Wrman f 3 e work for which this permit is issued,1:shall not employ any'person in such manner as to beco a subject or s mpensation laws of California." i '--` Sig d ------------- Owner-`-------- .. y - ----__------- --___''-- ---__-"------------------'-"--- j ----___ -- - -- k -- t _ - T-!-f(-®--------- Title - ------- V ------------------------------ - k --------------------------- -- ------------------ (If other than owner) FOR DEPARTMENT USE ONLY DATE == ----7 Z..._. APPLICATION ACCEPTED BY -.--_N- 'O------------------ BUILDING PERMIT ISSUED "' -: -------------------- ----=------ - -- ----- --------- _-DATE --.,�_.._ -------- -----. ADDIT•I©NAL-COMMENTS--------- _v. �`_-�-,—� 0- ja,-e -- --_ - �- --- --------------------------------------- -------- j ''= -------------------------------------------------------------------------- ---------------- - ----�--- ---'----------- -- ------------- Date- - ----- --- --------"".__ ..- Final Ins n b y: .- SAN JOAQUIN LOCAL HEALTH DISTRICT F H 9 1-'68 Rev. 5M ��-_