73-449 - Laserfiche WebLink

Home Browse Search

(`OR OFFICE USE: 5 APPLICATION FOR SANITATION PERMIT .........�............. Permit No. -73.............. ..�L�y JJ ,(Complete in Triplicate) 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. a2_2s� JOB ADDRESS/LOCATIO ;. -- rrr .-. 1 / /� �a -- � � � �r ,� �i- - r.� 1&.... CENSUS RAC'I __....� Owner's Name c _..L..k.v.............` [>.t! = Phone �a Address .............. ........ . .0..��.'�. ...�f�.�f`�...... City ... Contractor's Name ___. 2c4 -......................... License # � -��r Phone . 66 ............. . Installation will serve: ?Residence 22 impartment House❑ Commercial ❑Trailer Court 0 I Motel ❑Other ................................ .......... J r Number of living units:....... Number of bedrooms -:a......Garbage Grinder Lot Size .�`��-_��f��'��.•.... Water Supply: Public System and name ------- ...........................-----------------------------..............................................Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑� Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material .......... If yes, type ............................ [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,) PACKAGE TREATMENT SEPTIC TANK Size.._.__ ,/ .-_._.__...__,---- Liquid Depth ......... Capacity J ..... Type '�4` .. Material.. Compartments rc:�................. _ ..........Distance to nearest: Well ........... ....Foundation -.1O-� g Prop. Line .�s LEACHING'LNE ( �- Noof lines w_ Length of each l.ne �5 ... rToa Length'D' Box rialI. DeptFilter Material ....'� ...... nearest- nearest: Well ... .l.. - Foundation f.......... Property Line __ ......... ..... k r___... Diameter ��, .... . Number - ----.- Rock Filled Yes No SEEPAGE PIT ( Depth .�`5._.__ . I .. .'. � _-�- � � �j�~❑ Water Table Depth ----....... .......Rock Size _��L .. i . .1..---,-q-.--•-------- .... - -----•-•--•---•---- Distance to nearest: Well ......... (!....!?�1...................Foundotion 14---j........ Prop. Line . .......... REPAIR/ADDITION(Prev. Sanitation Permit 5# ............................................ Date .._ .............................. SepticTank (Specify Requirements) ................................................ ..................................--..........-....................................... DisposalField (Specify Requirements) ....---•----•------------------------------------------------------------------•- ----------------------------.-..................... .....................................-•--•--•----•-••----.--. ------- ---...----...._•----.._..-------------• •--•-----•-k-•---............_......---•-•---- (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 licew 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 By Title s (if other"th caner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... . - - - - -------------•-------------------------------------•--------------------------------._. DATE .-----•-------------- ....�?.........._... BUILDING PERMIT ISSUED ..... ..... ...........................:.—---................................. ......DATE ----------------------------------- ADDITIONALCOMMENTS ...................................•---•-•-•----•------....--•-------.-........:.._.--•------------..----•--._-----_-------------------------- ----------- ....._.....................................................................................................................i. ......................_.._..................._.._._.._................._._.. ......................•_____._...._...--........._...._•.....--_.............._..___.__._...._._.......__.............._._.�_.._.__....._._....._....._....___......_...................._.___..._....... .............................•......... .. ...:.. _ .. ... _._.._..--_. _ ................ ..................................................... ......... .............. ......... �_ _ Final Inspection by. ......Dote SAN JOAQUIN LOCAL HEALTH DiSTRICT E. H.13 241-'68 Rev. 5M 7/72 3 M