72-796 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: i APPLICATION FO OSANITATION PERMIT y (Complete in Triplicate) Permit No,. ------- --•--------------------------------- r ------------ --------------------- ----------------------------------- This Permit Expires 1 Year From Date Issued Date Issued _47_t22" 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 �C�ofunty Ordinance-No:_549 nd existing Rules and Regulations: JOB ADDRESS/LOCATION _YJU_._--- t�' ---y`��`Y�-----------------------------------------------CENSUS TRACT -------------------------- [ Owner's Name ------SI\M F)?A4Nco------------------------------------------------------------------ -------Phone --4%4'45_545--3------- Address ----- � L+ sJ.b4dG.. S`G-------------------------------------- Cit 3-Tc(VTON Contractors Name ------9ARR.JSd--- - SNS---------------- - ------------------License # ------------------------ Phone --------------------------•--- i Installation will serve: Residence 94partment House❑ Commercial :❑Trailer Court In Motel ❑Other ------------------ ------------------------ i 1 I Number of living-units.--.---.I--�=Number of;bedrooms --- ----- Grinder _...k _-Lot Size --- 7' ___________________ . .. - -- ---� --- -� 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 s' Fill Material ----- ------ lf,)es, type ----------------------------- Plot ----_-------c-=---_--t--Plot pian, showing size oflot, location of.system in relation.fio wells, buildings, etc. ;must_be placed on reverse side.) S� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT, .[ ] SEPTIC TANK Size-- -- C_�-Y--------------------- ______ Liquid Depth --��._.------------- � _ __Capacit -_ -- TypeC � t -- No. Compartments ---------------------- Di :stance. to nearest: Well ------------------------------------Foundation ___/6------------ Prop. Line --- _ LEACHING LINE No. of dines -------- /----__.__ Length of each line_-------S-�------ /f }� ------- Total Length :--�-�-Q-------------- 'D' Box _____________ Type Filter Material _!�- ------ Filter Material ____/------------ i>------------ Distance ito-nearest: Well _____________________ foundation ..1 __..___-Property Line ----. _11-4--________. SEEPAGE PIT [� Depth __.__��-- Diameter 3-C----- Number ---------------------------- Rock Filled Yes V Nolo Water Table Depth _,.-Rock`Size - _!----- ---- -}--------- Distance ____ __Distance to nearest: Well ----------------------------------------Foundation __1 Q__?'t___- Prop. Line --____---_ J REPAIR/ADDITION(Prev, Sanitation Permit#___________________________________________ Date --------------------.-__--________) Septic Tank (Specify Requirements) ___ _ _ ' ! -------------- 's" "*�} * - Disposal Field {Specify Requirements) ________________ ___ -------------------------------------------------------------- --------------------------------------------------------------------------------------------- -------------------- ------------------------ ---------------------- ------------------------- ---------------------------------------------------- ---------------------- --------------- - .. --- - - ----------------------- a -(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, I shall not employ any person in such manner r as to becomes ject to Wman's Compensation laws of California." i Signed ------: c /t' ----------------------------- Owner BY -------- ---------------------------------- ' -- -- Title,_-' `_-------------------------------------------------------- (If other than owner), _ _ t' >' L L. ke �_ a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __._. p BUILDING PERMIT ISSUED ------ / DATE - '� - DATE ------------ ADDITIONAL COMMENTS - ------------------------------ - ------------------------------------------------------ --- --- ------ -------- - -Z ------------------------------------------------- --------- - - ---------------------------- ---- ---- - - ------------------------------ Final inspection by: ------•---- --- --- -- ---- -- --Date . �. SA JOAQU! LOCAL HEALTH DISTRICT a E. H. 9 1-'68 Rev. 5M