73-418 - Laserfiche WebLink

Home Browse Search

FOR OFFICE: �r 5"_-, APPLICATION FOR SANITATION PERMIT 73 _�Ig f Permit No. - (Complete in Triplicate) ----__--___ This.Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the ISon 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: i JOB ADDRESS/LOCATION .--/.- - - -----/�C---------------------CENSUS TRACT -------------------------- r � Owner's Name �'1'Lid -_ U-Q--l�-1n1--------------------------------------------------------------- -------Phone -----------------------------_------ Address _f_76 5 revFJs� -1-----��--�---- - city � . -- - --------- -- sContractor's Name .-_ -----------------------------------------License � 1�__ Phon _ _ Installation will serve: Residence ['Apartment House[] Commercial :❑Trailer Court i❑ 'f . I Motel ❑ Other -------------------------------------------- Number of living. units:------- Number of bedrooms _______Garbage Grinder ------------ Lot Size -_____________________________`_____ Water Supply: Public System and �ame --------------------------------------------------------- Private Character of soil to a depth of 3 feet: Sand Silt C] Clay .❑ Peat❑ Sandy Loam •❑ Clay Loam.E3 Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ____-______________________ I r (Plot plan, showing 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,) {n i PACKAGE TREATMENT [ ] SEPTlCTANKf ] Size_______________________________________________ Liquid Depth __________________________ Capacity ------------------ Ty pe ---------------- Material----------- ---------- No. Compartments ------ ------ VN Distance to nearest: W -------------- ------------------Foun ation ---------------------- Prop. Line ---------- .--.------ LEACHING LINE No. of Lines [ ] Length of each line ---------------------- Total Length :---------------------_-_--- 'D' Box __ _-__Y - Type Fater' I __________ YpPth Filter Material ---- Distance to nearest: Well ___ _____________ Found ion _______________________ Property Line __-_-_.--.--..__--....._SEEPAGE PIT [ ] Depth _____!______________ -Di ________________ Nu er ________________________-__ Rock Filled Yes ❑ No ipWater Table Depth ----- ------------------------ ------•Rock Size --------------------------------Distance to nearest: Wel ____________________ ________Foundation -----------_--_____ Prop. Line ___________________-__REPAIR/ADDITION(Prev. Sanitation Permit# ____ _______________-__________ Date ___________________.__-___.----_.-I SepticTank (Specify Requirements) ------------------- ---------------------------------------------------------------------=------------------------------------------------- Disposal Field (Specify Requirements) __f1YF /'� __.._ - - �___ -� �� _ \ �^ -- -- ----- --------------------------------------------------=------------------------------------------------------------------------------------------------------------------------------------------------- j (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- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed &---.____ Owner -- - -- -- -- - -------------------------------- BY -' Title --- - ---- -- --- ------------ ------------------- - ----------------------------- ---------------------------- ,fl(lf other than owner) i FOR DEPARTMENT USE ONLY /� DATE ��' �'` - APPLlCA7lON ACCEPTED BY _.______tE_____f�` BUILDING PERMIT ISSUED----------- '--- ---------------------------- ------------------------------------------------------------DATE ------------------------------------------- IADDITIONAL COMMENTS ------- --- ------------------------------------------- -•----•----------- -------------- ------------------------------------------------ ------------------------------------------------- -- --------------------------------------------------------------------------------------------------------------- i ---- ------------------ ---------------------- ---------------------------- - ----------------------------------------------------------------------- ---------------------------------------------------- - - Final Inspection b ---- --------- ---.Date -----+57_ :?-�--"�- p Y = ----------------------- - s SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M Q i